AccountId: 011433970860
ContactId: e8857715-8099-4460-b571-4181c4f2a36b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 391920 ms
Total Talk Time (AGENT): 182342 ms
Total Talk Time (CUSTOMER): 145462 ms
Interruptions: 3
Overall Sentiment: AGENT=2.1, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/e8857715-8099-4460-b571-4181c4f2a36b_20250529T17:26_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I'm calling you because I have a question of eligibility and benefits for a member. Can you help me with that please?
[AGENT][NEUTRAL] OK, so you're naming eligibility and benefits for a member, is that correct?
[CUSTOMER][POSITIVE] That is correct, yes.
[AGENT][POSITIVE] Yes, ma'am. I can help you with those things. And could you please spell your name for me?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Thank
[AGENT][NEUTRAL] OK, thank you. And the, the first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Perfect, thank you.
[AGENT][POSITIVE] You're welcome. And what is a good callback number for you please, [PII]?
[CUSTOMER][NEUTRAL] Callback number it's, let me give you here this one.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] I'm sorry, [PII], it's uh uh the initially and then [PII].
[AGENT][NEUTRAL] OK, thank you and the member's policy number please [PII].
[CUSTOMER][NEUTRAL] Member's policy number is let's see one moment here.
[CUSTOMER][NEUTRAL] All right. It is like, um, I'm sorry, secondary insurance, it's coverage.
[AGENT][NEUTRAL] Do you have a copy of the ID card, [PII]?
[CUSTOMER][NEUTRAL] Oh my [PII], I.
[CUSTOMER][NEUTRAL] Yes, I have a copy of that.
[AGENT][NEUTRAL] OK, so,
[AGENT][NEUTRAL] On the ID card, depending on the type of policy it is, you may see an in-hospital or outpatient number.
[CUSTOMER][NEUTRAL] Yes, um.
[AGENT][NEUTRAL] It might give me
[CUSTOMER][NEUTRAL] I think that we are in.
[AGENT][NEUTRAL] OK. So in hospital, yes, ma'am. Just so you know, it said the very first part of both of those numbers is the same before the letters ML. So that's actually the policy number. So just give me the first part of either one of those numbers.
[CUSTOMER][NEUTRAL] So this one it's 02.
[CUSTOMER][NEUTRAL] It's 7.
[CUSTOMER][NEUTRAL] All right. Uh, um, the, the numbers are 0220.
[CUSTOMER][NEUTRAL] 39
[CUSTOMER][NEUTRAL] 39
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] This is for [PII]. The date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so it's uh, again, any information provided will be a verification of benefits and not a guarantee of payment. I do show that she is the spouse of the subscriber on the supplemental policy, and it is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] And what type of benefit information do you need inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Uh, this is for office.
[AGENT][NEUTRAL] OK, so on this, let's see.
[AGENT][NEUTRAL] So on the supplemental policy, office visits are not covered.
[AGENT][NEUTRAL] If they were to receive some form of treatment in the office that could be reviewed the treatment can be reviewed under their outpatient benefit.
[AGENT][NEUTRAL] And the outpatient benefit maximum per calendar year for covered outpatient services is $6000 with no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Alright, but for office visits are not covered on the member's plan, right?
[AGENT][NEUTRAL] That is
[AGENT][POSITIVE] That is, that is correct.
[CUSTOMER][POSITIVE] All right, thank you very much for that. Uh, let's see one moment here.
[AGENT][POSITIVE] Yes, ma'am. You're welcome. Now.
[AGENT][POSITIVE] And so just a couple of additional, sure, I'm gonna give you a couple of additional pieces of information as well.
[CUSTOMER][NEUTRAL] Give me a moment. Let's
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, this is American Public Life, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] All right, let's see here.
[CUSTOMER][NEUTRAL] So this would be [PII].
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] M L and the last number will be 7.
[CUSTOMER][NEUTRAL] Alright, um, you say your name is [PII], right?
[AGENT][NEUTRAL] Yes, and my name and today's date would be your call reference number. Now if you all end up filing a claim it's uh with us for this number, we would also have to have a copy of the primary insurance company's explanation of benefits.
[AGENT][NEUTRAL] As well for review and then once we have processed a claim here at APO we do have a portal that you should be able to check claim status for us in by going to secured. [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, perfect. So, OK, but um in this case I think that we don't, we don't need to submit a claim because visit offers are not covered on the member's plan.
[AGENT][NEUTRAL] Yes, we on this policy only treatment would be eligible for review.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, so uh. All right, thank you very much for that. I really appreciate it, [PII]. Have a wonderful day. Take care. Bye-bye.
[AGENT][POSITIVE] Well, you're welcome. Yes, ma'am. I said well that's all I can help you with. Thank you again for calling APL and I hope you have a nice afternoon also.
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][POSITIVE] Thank you, bye.
[AGENT][NEUTRAL] Bye bye.