AccountId: 011433970860
ContactId: f16e2fc3-b221-4f81-ba68-31cf7b180285
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 604280 ms
Total Talk Time (AGENT): 200259 ms
Total Talk Time (CUSTOMER): 240693 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/f16e2fc3-b221-4f81-ba68-31cf7b180285_20250107T19:19_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. Who am I speaking with?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. Um, my mom [PII] has a policy with you guys. She's currently in the hospital right now. Um, she had surgery so she could barely talk. I'm gonna let her give you permission to talk to me. Hi, this is [PII].
[CUSTOMER][NEUTRAL] You got my permission to talk to my daughter [PII].
[AGENT][NEUTRAL] OK. Your
[AGENT][NEUTRAL] OK, give me your date of birth real quick.
[CUSTOMER][NEUTRAL] She's also my beneficiary of my policy. [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, what is the policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hold on, let me pull it up. It's is.
[CUSTOMER][NEUTRAL] The policy number is 217.
[CUSTOMER][NEUTRAL] 1067
[AGENT][NEUTRAL] OK, and [PII], what is the uh phone number in case I lose you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK perfect.
[AGENT][NEUTRAL] OK, and how can I help you?
[CUSTOMER][NEUTRAL] All right, the reason we're calling is we want to go over her.
[CUSTOMER][NEUTRAL] Benefits for this particular coverage so we can know what we need to do a claim for.
[AGENT][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] And and how does it work? Can you explain to us her benefits under this group hospital indemnity policy?
[AGENT][NEUTRAL] OK, give me a second, let me pull her policy.
[AGENT][POSITIVE] Hopefully it's loaded.
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] It is OK.
[AGENT][NEUTRAL] OK, it looks like she has a hospital.
[AGENT][NEUTRAL] Benefit, so once she became admitted it's gonna pay.
[AGENT][NEUTRAL] I don't know which one she has so because I can't see it I would actually have to transfer you to web TPA.
[AGENT][NEUTRAL] But I'm just gonna go over what it could be if that makes sense. So when she was admitted it could be either $100 or $500. I don't know if she got the low policy or the high policy.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And then um
[AGENT][NEUTRAL] Daily confinement can be anywhere from 300 a day to 800 a day.
[CUSTOMER][NEUTRAL] First
[AGENT][NEUTRAL] And then surgery is.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Uh, up to 2000 or up to 4000. It just really depends on which one she got, the high or the low.
[CUSTOMER][NEUTRAL] OK, and do these benefits get paid to her directly or to the hospital?
[AGENT][NEUTRAL] Yes, no, no, if she submits the claim it'll pay to her if the hospital submits the claim it'll pay to the hospital. It's whoever submits the claim first.
[CUSTOMER][NEUTRAL] OK. So we need to submit a claim.
[CUSTOMER][NEUTRAL] Well, well, two things. So.
[CUSTOMER][NEUTRAL] Back in [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII], she was admitted in the hospital for nine days and she had to have surgery. We didn't know she had this coverage. No one ever said anything. So we didn't file a claim.
[CUSTOMER][NEUTRAL] Back then.
[CUSTOMER][NEUTRAL] Um, so we need to know if a claim was filed on the behalf of her, if the hospital did one. If not, we need to file a claim for that stay and also her current stay right now.
[AGENT][NEUTRAL] OK, um, I can't see anything I would.
[CUSTOMER][NEUTRAL] She's back in the hospital. She had to have surgery.
[AGENT][NEUTRAL] OK, I can't see if any it does to me it doesn't look like any claims were filed, um, but I can always transfer you to web TPA and they can look but um we don't have any timely so you can file that claim from [PII] if it hasn't already been filed we just need an itemized statement from the hospital that shows the time she was admitted, the time she was discharged, along with the diagnosis, the whole reason for her hospital stay.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then all procedures that were done.
[AGENT][NEUTRAL] You know, I surgery charge, the anesthesia, yeah. And um then you can just submit those to us and then we can go from there.
[CUSTOMER][NEUTRAL] Alright, one
[CUSTOMER][NEUTRAL] OK, can you give me one second? I'm trying to, OK, I'm trying to write it down, but you're moving so fast, so you need an autoized statement. You need the time and date that she was admitted to discharge.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] And all of this will be in the out of my statement if I ask the um hospital for it?
[AGENT][NEUTRAL] It should be, yes. Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Submit it and discharge date.
[CUSTOMER][NEUTRAL] The diagnostics and what, what surgery she had?
[AGENT][NEUTRAL] Diagnosis
[AGENT][NEUTRAL] No, just the codes. It shows that she had surgery, so that way we could pay the surgery benefit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And codes showing she had surgery.
[CUSTOMER][NEUTRAL] All right, and
[CUSTOMER][NEUTRAL] How do, once I get that information, how do I file a claim?
[AGENT][NEUTRAL] Uh, you would file, let me see, this web TPA.
[AGENT][NEGATIVE] I, I don't, I will have to transfer you to them because they administer it, it's not us.
[AGENT][NEUTRAL] So um I can go ahead and get you over to them and they can tell you the rest of it.
[CUSTOMER][NEUTRAL] OK, and they'll be able to tell me exactly what, like whether it's 300, 500, 500, 800?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] And let me give you their phone number in case, yes [PII].
[CUSTOMER][NEUTRAL] OK, do you have a number for them?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And if you give me 1 2nd I'll get you over there, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] Well that's not good.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] That's why.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Welcome to Web TPA, the administrator for the limited benefit health insurance program underwritten by American Public Life Insurance Company. If this is an emergency, please hang up and dial [PII].
[CUSTOMER][NEUTRAL] If you are a member calling about your premium billing or need to make changes to your account, such as an address change, add or drop a dependent, or wish to modify your coverage in any way, please call American Public Life at [PII]. If you are a physician or hospital calling to verify medical eligibility, please press 1. For information and phone numbers for the Beach Street PPO network, please press 2.
[CUSTOMER][NEUTRAL] For questions concerning pharmacy services, you may contact Caremark at [PII]. To speak to a customer service representative regarding any other issues, please press 3 now or simply stay on the line and someone will assist you. Thank you.
[CUSTOMER][NEUTRAL] Please note, your call may be monitored or recorded for quality assurance. The information provided during this call is only a description of benefits and is not a guarantee of payment. Benefits are based upon eligibility at the time services are rendered and all plan provisions.
[CUSTOMER][NEUTRAL] Thank you for calling customer service this is [PII]. Can I get the member ID number?
[AGENT][NEUTRAL] Hi [PII], this is [PII] with APL. I'm gonna be transferring over uh [PII] and her policy number is 02.
[AGENT][NEUTRAL] 17
[AGENT][NEUTRAL] 1067.
[AGENT][NEUTRAL] She's calling on behalf of her mother, [PII]. I did speak to [PII]. I did get permission to speak to her. She's been fully verified. They just want to go and see if there was any claims submitted for [PII] and also what her benefits is because she's currently in the hospital.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right?
[AGENT][NEUTRAL] Is there anything else you need from me?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, no, that's fine, thank you.
[AGENT][POSITIVE] No problem. Alright, here she goes. Thank you.
[CUSTOMER][POSITIVE] Thank you.