AccountId: 011433970860
ContactId: ec6a0dce-079e-40d1-9f0b-d2eeb8cb0832
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 609369 ms
Total Talk Time (AGENT): 228718 ms
Total Talk Time (CUSTOMER): 319948 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/30/ec6a0dce-079e-40d1-9f0b-d2eeb8cb0832_20250530T17:23_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, patient eligibility benefits please.
[AGENT][POSITIVE] OK, I can help you with both the eligibility and benefits. May I have your name and a good contact number?
[CUSTOMER][NEUTRAL] My name is [PII] calling. My phone number is [PII].
[AGENT][NEUTRAL] Thank you. May I have the member's policy number?
[CUSTOMER][NEUTRAL] 02610047.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] That's not
[CUSTOMER][NEUTRAL] 00 my [PII]. Her last name is, I'm gonna spell it, I'm gonna say it wrong. [PII] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So I am showing the policy is active. It's been effective since [PII].
[AGENT][NEUTRAL] And what type of benefits did you want to go over today?
[CUSTOMER][NEUTRAL] So she, she came in for like an express care. So that means like, like a, like a walk-in facility but for like a quick treatment, right? For something quick like a uh no, it's like a cough, a cold, you know what I mean?
[AGENT][NEUTRAL] Like urgent care?
[AGENT][NEUTRAL] Right, but are you an urgent care facility or are you like an outpatient facility?
[CUSTOMER][NEUTRAL] We're, we're, we are an outpatient, but we have, but we have different facilities. We have the express care, we have urgent cares, we have diagnostic facilities, and I mean we're, we have many different facilities.
[AGENT][NEUTRAL] Right, OK.
[CUSTOMER][NEUTRAL] So she just like I said she she just came let's see.
[AGENT][NEUTRAL] But the policy
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] The policy is only broken down between inpatient and outpatient. So for the outpatient benefits, we will pay up to $5500 per person per calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you want me to see if it has been used?
[CUSTOMER][NEUTRAL] So is she covered, yeah, so she, she's covered for that like outpatient express care coverage so meaning like a cough, cold, pink eye, earache, rashes, muscle strains.
[AGENT][NEUTRAL] We, this policy is a secondary policy, so it doesn't really cover what's being done, it's where it's being done. So if you're an outpatient facility, um,
[AGENT][POSITIVE] Yes, that there is coverage for that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK, so is that how your plans go? So it's really not for like any specific benefit. It's just if it's outpatient it's it's just covered automatically?
[AGENT][NEUTRAL] Right, so what you're, what you're giving me are symptoms, are, are like illnesses. Our policy doesn't go by what what the issue is, it's, it goes by where it's done. Is it inpatient where they admitted into the hospital, was it outpatient, were they in an emergency? Right. So that benefit goes for any outpatient, it does, if it's a
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Or that by outpatient.
[AGENT][NEUTRAL] Out, they even have physician office coverage. It, it would be outpatient if they're not admitted into the hospital.
[CUSTOMER][NEUTRAL] So this is like so OK so this is outpatient but it's outpatient express cares. Should I say that instead? Does that make more sense?
[AGENT][NEUTRAL] So yes, that
[AGENT][NEUTRAL] It it's just outpatient. It's an outpatient facility.
[CUSTOMER][NEUTRAL] Oh, OK, so I have a question for you. So next time when I call American Public Life, is it just better to say that instead of saying what's the benefit, do I, do I, do I what do I say? do they have outpatient coverage or do I just say, oh hey, do they have outpatient urgent care coverage or?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, yeah, you would just say you're just calling for, um, you're just calling to verify outpatient benefits.
[CUSTOMER][NEUTRAL] Oh, OK, because, OK, so just, just, just say that instead instead of saying hey, no, I shouldn't say hey, but you know, hey are you know what I mean, hey, are, are they, are you, are do they are they covered for outpatient instead of saying outpatient urgent care, just say are they covered for outpatient services.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Well, you can
[AGENT][NEUTRAL] Well, no, you can, well, I would just say I'm just calling to verify benefits for outpatient urgent care facility and then they would.
[CUSTOMER][NEUTRAL] You know what I'm trying to say?
[CUSTOMER][NEUTRAL] Well, this is, well, but this is not urgent care, it's express care. This is different.
[AGENT][NEUTRAL] OK, so it doesn't matter if it's not, if they're not being admitted into the hospital, it's outpatient, so it would still be the same benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so, so again, the next time I call just ask from for, for the out if there's any outpatient benefit?
[AGENT][NEUTRAL] Yeah, just let them know you're calling to verify outpatient benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'm writing this down.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Outpatient
[CUSTOMER][NEUTRAL] And then they'll let me know, um.
[CUSTOMER][NEUTRAL] And they'll let me know so once I say that, what what then will they let me know like.
[AGENT][NEUTRAL] Once you say that, let us know that you're wanting to know what's covered under outpatients, so we will give you the calendar year max, and we will let you know if any has been used or if they haven't used any for the year.
[CUSTOMER][NEUTRAL] I it what's included or not?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so calling to verify outpatient, uh, benefits, right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, that's I guess that's just easier to say.
[CUSTOMER][NEUTRAL] Instead of saying are they covered for this and that, I always, I try to go above and beyond and ask all the questions I can think of.
[AGENT][NEUTRAL] Ah
[AGENT][NEUTRAL] Yeah, every policy is different, but um, I mean, some policies do go by what what is being done and what's being given, um, ours just is the place of service.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Places there, OK.
[CUSTOMER][NEUTRAL] Which is outpatient.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, because some plans, you know, OK, it's just the place of service APL.
[CUSTOMER][NEUTRAL] Which is uh service which is outpatient or or inpatient, OK.
[AGENT][NEUTRAL] Right, now each every, there's different policies for APL, so for this particular policy, yes.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right, indemnity, you have indemnity and you have the, the, the supplement. This is a supplement.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] I do know that one, [PII].
[CUSTOMER][NEUTRAL] I do know that one.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][POSITIVE] OK, no, it's always, no, it's always, it's always good to learn, you know, because there's so many different things out there, you know, and it's, and it's like I try to go above and beyond and ask all the right questions and everything and this and that and this and that and it's just like I, I, I.
[AGENT][NEUTRAL] It is.
[AGENT][POSITIVE] Well, it's OK, that's totally fine. That's what we're here for.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, so let me see something here. OK, so and then is is is she the subscriber or is it her husband for this one?
[AGENT][NEUTRAL] Um, her husband is a subscriber.
[CUSTOMER][NEUTRAL] Her husband? OK, perfect. And is there any group name for this one?
[AGENT][NEUTRAL] I see.
[AGENT][NEUTRAL] The group name is, I'm just gonna spell it, N A.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] VAL.
[CUSTOMER][NEUTRAL] Oh, and
[CUSTOMER][NEUTRAL] N A V A L, Naval, uh-huh.
[AGENT][NEUTRAL] It's all together. I am.
[AGENT][NEUTRAL] Like Mary, P I.
[AGENT][NEUTRAL] A
[AGENT][NEUTRAL] N like Nancy, T [PII]
[CUSTOMER][NEUTRAL] It's all one word?
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] What the heck does that mean? What is this? navel and I don't even know.
[AGENT][NEUTRAL] In Plan, I have no idea. And then [PII].
[CUSTOMER][NEGATIVE] I ain't got no clue.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] OK, perfect. Uh and I INC.
[AGENT][NEUTRAL] And then incorporate it.
[CUSTOMER][NEUTRAL] OK, right, INC?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, and then group number is 23754, right, [PII]?
[AGENT][NEGATIVE] Yes, no.
[AGENT][NEUTRAL] So you said the group number?
[CUSTOMER][NEUTRAL] No, yes.
[AGENT][NEUTRAL] The group number is 27008.
[CUSTOMER][NEGATIVE] People be putting the wrong thing.
[CUSTOMER][NEUTRAL] OK, perfect, and it's [PII] or A N [PII]?
[AGENT][NEUTRAL] [PII] N N A.
[CUSTOMER][NEUTRAL] Ah,
[CUSTOMER][POSITIVE] OK, and there's gonna be A and then A and your name in today's day. I can't believe it's already the end of the month. That's wild.
[AGENT][NEUTRAL] I know it's going by fast.
[CUSTOMER][NEGATIVE] Time needs to slow down.
[CUSTOMER][NEUTRAL] OK, so that's good to know. You taught me something. So next time when I call, I'm just gonna ask, um, just calling to verify outpatient benefits.
[AGENT][NEUTRAL] Yeah, and then they'll know exactly what to say.
[CUSTOMER][NEUTRAL] Yeah, I think, I think when I, I think I'm gonna start saying that when I call other insurances to see what they say.
[CUSTOMER][NEUTRAL] And do you know because maybe that's better than say maybe that's better than saying you know urgent care, you know, but then my fear is it's like if I say that I don't tell them what what they came in for are they covered are they not, you know what I'm saying.
[AGENT][NEUTRAL] Yeah, if once you tell them what you what you need, if they need more information, they'll, you know, they'll ask the questions to get it out of you.
[CUSTOMER][POSITIVE] I, I hope so.
[CUSTOMER][POSITIVE] OK, OK, perfect, and this is there.
[AGENT][NEUTRAL] Well, [PII], was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] I'm trying to think, is there anything else? No, not for now until, oh yeah, right, this is their medical policy, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Alright thanks and I hope you have a great weekend.
[AGENT][POSITIVE] You also, and thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.