AccountId: 011433970860
ContactId: f034ba26-d84b-4576-983e-f71748aa13f1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 556719 ms
Total Talk Time (AGENT): 217526 ms
Total Talk Time (CUSTOMER): 362422 ms
Interruptions: 17
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/f034ba26-d84b-4576-983e-f71748aa13f1_20250507T19:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Uh, my name is [PII]. I am a, um, I, I'm insured through American Public Life, uh, in the GAP program, um, and I just wanted to, I guess, get some clarification on my benefits.
[CUSTOMER][NEUTRAL] Um, what information do you need from me to, I guess, pull up my like my account?
[AGENT][NEUTRAL] OK, I'm needing a callback number just in case the call is disconnected.
[CUSTOMER][NEUTRAL] Oh yeah, uh [PII].
[AGENT][NEUTRAL] And may I have your policy number?
[CUSTOMER][NEUTRAL] Is that my payer ID?
[AGENT][NEUTRAL] It would be the outpatient or inpatient cert number.
[CUSTOMER][NEUTRAL] Or is that my group number?
[CUSTOMER][NEUTRAL] Oh, OK, I have the outpatient benefit. OK. 0261.
[CUSTOMER][NEUTRAL] 0088 and then letter M as in monkey, L and 8.
[AGENT][NEUTRAL] Thank you. And may I have your date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] And I do need to verify the mailing address and an email address listed on file.
[CUSTOMER][NEUTRAL] OK. Uh [PII] and my email address is uh [PII]. Or I might do my work email [PII].
[AGENT][NEUTRAL] OK, the one that we do have is the personal email.
[CUSTOMER][POSITIVE] Perfect. OK. Great.
[AGENT][POSITIVE] And thank you so much for verifying the policy. You were calling in to see what type of benefits that you have for this policy.
[CUSTOMER][NEUTRAL] Yeah, just get an understanding in general of, of what my uh insurance covers. And then I have a specific example um where I'm really hoping that you all can help cause it'll be the difference of whether I can, you know, access that service or not.
[AGENT][NEUTRAL] OK, do you know if the service is gonna be rendered within an office setting, outpatient facility, or inpatient?
[CUSTOMER][NEUTRAL] I'm not sure what inpatient means. Is that like a hospital? Is that what inpatient means?
[AGENT][NEUTRAL] Inpatient would mean that you're confined within a hospital.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Oh yeah, no, no, no, no. Um, this, it's physical therapy, so I'm not sure. It's at like a, a physical therapy center.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] As part of my, um, like rehabilitation for my knee.
[AGENT][NEUTRAL] OK. Now, will you be receiving physical therapy, occupational therapy?
[CUSTOMER][NEUTRAL] Physical therapy.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And I'm pulling that information up for you now.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you're calling in for physical therapy benefits, verification of coverage does not guarantee the payment of the claim. For physical therapy, you do have up to $3000 per calendar year that will go towards the primary insurance deductible, co-insurance, or co-pay. This policy is for sickness and injury only. It does not cover any type of preventative or wellness. Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] It's uh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's what I what I do.
[CUSTOMER][NEUTRAL] It's what I told her.
[CUSTOMER][NEUTRAL] Um, OK. So just to clarify, um, cause it sounds like it does. I, I, I basically owe a co-pay every time I go. So this would, it sounds like it would cover my co-pay for physical therapy. I have an injury. Um, I guess my question would be, how does it, how, how do I get that to work? Um, uh, do I have to submit, like, do I have to pay upfront and submit as a reimbursement, or is there a way to get you all to just
[CUSTOMER][NEUTRAL] To be billed directly to you all.
[AGENT][NEUTRAL] You will present this card as well?
[CUSTOMER][NEUTRAL] I'm not quite sure cause, yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You will present this card as well as your primary card. It is to provider's discretion if they would like to submit the primary EOB over to us once the primary insurance processes the claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Then you would have to check with them to see if they will accept secondary insurance, and if they do, then they will submit the information as needed once primary has processed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I was
[CUSTOMER][NEUTRAL] OK, sounds good. Um, otherwise, if they say no, then, um, I'm able to submit like, like I pay it and then I, what do you all need from me in order to get reimbursed?
[AGENT][NEUTRAL] OK, if you were submitting it, you will have to wait until the primary insurance process that claim to show that you did have a patient's responsibility, you would then have to submit that primary EOB with the diagnosis code from that provider.
[CUSTOMER][NEUTRAL] I was wearing my glasses. I got all the tips and she just
[CUSTOMER][POSITIVE] I like already
[CUSTOMER][NEUTRAL] or not.
[CUSTOMER][NEGATIVE] And I felt like my glasses like slipping and I looked at a little corner. I threw all my tips, my glasses down there, so I just kept.
[AGENT][NEUTRAL] And once we receive that needed information, we then will review in the process if able.
[CUSTOMER][NEUTRAL] OK. OK. Um, sounds good. And then, um, for, um, for other, like for specialists, for example, if I go to an orthopedic surgeon, um, what's, um, what's covered there just so I know.
[AGENT][NEUTRAL] OK, so in regards to any office visits and or procedures rendered within an office setting, for that, you don't have the office visit fee, so that does not cover your copay for the office visit. But if you have anything other than the office visit fee rendered within that service, you do have up to that $3000 per calendar year as well combined. So you just have a $3000 max that we would pay out.
[CUSTOMER][NEGATIVE] Like if the money at this point, yeah, or like let me like give me my I can't I can't sleep and like I can just started late.
[CUSTOMER][NEUTRAL] They ended up turning in just as.
[CUSTOMER][NEUTRAL] Well there are.
[CUSTOMER][POSITIVE] I was like oh my gosh.
[CUSTOMER][NEUTRAL] For both um physical therapy and uh for an orthopedic surgeon.
[AGENT][NEUTRAL] If it's, it's, it's if it's for the office procedure for that provider, you do have up to that $3000 so you only have a $3000 limit that we would pay.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Then whatever like I got them and then everyone was like, well I'm gonna do your chips. I was like.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Yeah, um, OK, sorry. Just so I understand, um, I'm not very good with these things. OK, so, um, for, for therapy, um, I have a $3000 max for those things you mentioned. And then, uh, for to see a specialist about something, you're saying it's the same $3000 max or it's a different 3000 max?
[AGENT][NEUTRAL] No, you have a combined $3000 max for those services.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For both, OK, for specialists and for uh physical therapy. OK. Um, is, and then what about, um, and that is total for the year for all injuries, or is it like per injury? Just wait a little.
[AGENT][NEUTRAL] It's per calendar year, not per occurrence, it's calendar year.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Per calendar year. Got it. OK. OK. So whether I have 10 things going on at one. OK, perfect. And then um what about for surgery? Like, um, like a hospital balance for a surgery?
[AGENT][NEUTRAL] If that was for outpatient, the outpatient benefit max is what I gave you, up to that $3000.
[CUSTOMER][NEUTRAL] Oh, same thing for surgery. OK. What if it's
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, that's if it's an outpatient surgery at a hospital. What if it's an inpatient? Just so I know.
[AGENT][NEUTRAL] For the inpatient, you do have up to $3000 for inpatient as well.
[CUSTOMER][NEUTRAL] I think.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. And that is separate from the outpatient benefits of 3000, right?
[AGENT][NEUTRAL] That is separate from the outpatient, yes.
[CUSTOMER][POSITIVE] Oh, amazing. OK. I really appreciate your help explaining all that. Um, where can I find my, um, where can I find like uh like an like a benefits summary or like an explanation of what you just gave me, um, for APL for, for my plan.
[AGENT][POSITIVE] No problem.
[AGENT][NEUTRAL] OK, you can go on to our secured portal which is [PII].
[CUSTOMER][NEUTRAL] I was just like
[AGENT][NEUTRAL] And you will set up a username, so go ahead.
[CUSTOMER][NEUTRAL] AM
[CUSTOMER][NEUTRAL] Sorry, [PII] or [PII]?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] It should be listed on your card.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh, let me see. You're right. Let me see. Like, oh, and public. I see it, I see it. Perfect. Yeah, uh, [PII] [PII] [PII], right?
[CUSTOMER][NEUTRAL] Yeah, I, I see it here. OK.
[AGENT][NEUTRAL] Yes, once you enter that information, you will set up your username and password and you will be able to download your benefit package for your policy.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][POSITIVE] Oh amazing. Alright, thank you, [PII]. I really appreciate your help.
[AGENT][POSITIVE] You're welcome and thank you for calling American Public Life, Deve have a
[CUSTOMER][POSITIVE] Hey, you too, bye bye. Thanks.
[AGENT][POSITIVE] Thank you. Bye.