AccountId: 011433970860
ContactId: e8f7623c-cf05-46a2-a045-1a05701212c9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 394470 ms
Total Talk Time (AGENT): 133844 ms
Total Talk Time (CUSTOMER): 179003 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/e8f7623c-cf05-46a2-a045-1a05701212c9_20250306T14:30_UTC.wav
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[AGENT][NEUTRAL] Calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling um to verify benefits. Um, I just got a call uh for a procedure I'm supposed to have and they said that I don't have coverage, so I think I do. So I was hoping you could help me.
[AGENT][NEUTRAL] OK, I'll be happy to verify benefits. May I have a policy number?
[CUSTOMER][NEUTRAL] Sure, uh, the policy number is 02444783.
[AGENT][POSITIVE] Thank you. May I have a good callback number for you?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] Can you verify your date of birth, your mailing address, and your email, please?
[CUSTOMER][NEUTRAL] Mhm. My date of birth is [PII].
[CUSTOMER][NEUTRAL] My mailing address is [PII].
[CUSTOMER][NEUTRAL] Uh, the policy is under my husband, so I'm not sure. His email address is [PII]. [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. Please be advised that verification of coverage does not guarantee the payment of a claim. This plan is effective [PII] and it is active.
[AGENT][NEUTRAL] Is there any benefits I can verify for you?
[CUSTOMER][NEUTRAL] Um, yeah, so, um, I'm supposed to have a lumpectomy on Monday.
[CUSTOMER][NEUTRAL] So the hospital just called me and said that that they're seeing the policy as inactive. They had the correct group number, policy number.
[CUSTOMER][NEUTRAL] They had
[CUSTOMER][NEUTRAL] I wonder if, I don't know, the effective date is like [PII], but you know, usually like it's only 1 year out.
[AGENT][POSITIVE] Yes, and it is active.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see if there's any notes in the system from a provider. Was this recent?
[CUSTOMER][NEUTRAL] Was it recent? Uh, it's scheduled for Monday. I think they were verifying benefits. I did have a biopsy at the same location and an MRI through the same, you know, hospital system.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] I don't know if something went through and if you see the claim for the MRI or the biopsy or if there was some reason why it got denied or they would think it's inactive.
[AGENT][NEUTRAL] Let me see if there's anything denied.
[AGENT][NEUTRAL] Do you have a data service?
[CUSTOMER][NEUTRAL] Um, just give me a second.
[AGENT][NEUTRAL] I'm showing um looks like a hospital on [PII].
[AGENT][NEUTRAL] A facility fee in which we ask for the primary insurance explanation of benefits.
[CUSTOMER][NEUTRAL] Yeah, so
[CUSTOMER][NEUTRAL] Um, on [PII], that was like the follow-up mammogram.
[CUSTOMER][NEUTRAL] Then on February.
[CUSTOMER][NEUTRAL] [PII], uh, so [PII], there would be a biopsy from that same location.
[AGENT][NEUTRAL] OK. I don't show that one in our system as of right now. Let me see if there's any open claims.
[AGENT][NEGATIVE] Because the first one for the facility was denied for EOB. It was not denied as not covered or not eligible.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Just checking to see if there's any open claims one moment.
[AGENT][NEUTRAL] There was an office visit on [PII]. It was received on [PII] and it is in line for processing.
[AGENT][NEUTRAL] That's from the dermatology.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that are the only claims that I'm showing as of right now.
[CUSTOMER][NEUTRAL] OK, I guess the hospital is really slow with their billing.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Yes, so we just need the major medical EOB to go with the hospital billing.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] OK, and is that like routine that you guys ask for the EOB from major medical first and then.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, because we pick up your co-pays, your co-insurance, and our deductibles behind the primary.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK thank you and then and so so then it's sort of like a delay on their billing side that you guys haven't received the ELB yet so that's why you haven't paid the claim yet it's just.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEGATIVE] But once, but it's, I don't know why they would say that the that it's inactive, it just got denied.
[AGENT][POSITIVE] Correct. For the major medical. The plan is actually active.
[AGENT][NEUTRAL] And they can fax it over.
[CUSTOMER][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, would they have the fax number like, does that come back with, with your denial or something?
[AGENT][NEUTRAL] It may be on the EOB, but I can give it to you and you can forward it to them if you like.
[CUSTOMER][NEUTRAL] Sure. What's the fax number?
[AGENT][NEUTRAL] It's 877.
[CUSTOMER][NEUTRAL] 877
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] 365.
[AGENT][NEUTRAL] 942-3 attention claims.
[CUSTOMER][NEUTRAL] Claims, OK, um, and then I just got a little confused on your prompts when I called in today. Um, it said like cancer and surgery and gap or something, but I pushed the first one, was it called medical and gap or something? Is that the, that's the correct spot where I'm supposed to.
[AGENT][NEUTRAL] Yes, ma'am. You're in the Metlink. You have the Metlink policy, so you pushed the correct one.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Medlink, like medical MED link.
[AGENT][NEUTRAL] MED Link, yes, ma'am.
[CUSTOMER][POSITIVE] OK, I wasn't sure if you said met, like metropolitan. OK. All right, [PII], I appreciate your help. Thank you so much.
[AGENT][POSITIVE] You're so welcome and thank you for calling American Public Life, Amy. Have a great day. Bye-bye.
[CUSTOMER][POSITIVE] Thank you. You too. Bye-bye.