AccountId: 011433970860
ContactId: f2596c23-178f-48dc-b96d-3aa541409a14
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 812140 ms
Total Talk Time (AGENT): 214553 ms
Total Talk Time (CUSTOMER): 396530 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/f2596c23-178f-48dc-b96d-3aa541409a14_20250411T17:28_UTC.wav
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[AGENT][NEUTRAL] APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, hi, [PII]. This is [PII]. You said your name is [PII]?
[AGENT][NEUTRAL] Yes, [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] [PII] My name is [PII], um so, I was calling because my doctor had ordered.
[CUSTOMER][NEUTRAL] Um, a sleep study for me and I guess, um, Blue Cosby Shield covering some of it and then I have provided them for APL, which is you guys, and they said um you guys can pick it up. So I was seeing if that's a coverage benefit for me. She gave me the code.
[AGENT][NEUTRAL] Can I have your, could I have your name and your policy number please?
[CUSTOMER][NEUTRAL] My name is [PII] and my policy number.
[CUSTOMER][NEUTRAL] Um, I think it's 02473340 ML the number 8.
[AGENT][NEUTRAL] Could you verify your mailing address and your date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] Thank you. Your birthday has been a couple of days. Happy birthday. Um.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] The email address that we have on file for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and what's your call back number just in case the call is disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And you're calling to verify if you have your coverage coverage sleep study. So is this gonna be taking place at the facility itself or would it be at home?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] At, at the facility.
[AGENT][NEUTRAL] OK, so you have outpatient benefits of $300 per calendar day, and this is not a guarantee of benefits, just a disclaimer of the policy's coverage. So your policy has up to $300 per calendar day that will go towards your deductible co-pay and co-insurance.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] So they need to call to verify your benefits. If they call to verify your benefits, but make sure you give them your um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Your gap insurance card as well when you give them your primary.
[CUSTOMER][NEUTRAL] I, and I did, and they said they did verify it and she said it didn't pick up.
[AGENT][NEUTRAL] No, I don't even see that in here.
[AGENT][NEUTRAL] They telling stories.
[CUSTOMER][NEUTRAL] She gave me a CCC code.
[AGENT][NEUTRAL] I don't need that. I, you just, I don't need that because you have outpatient benefits, so it's covered. Then there's no pre-authorization required here with American Public Life.
[CUSTOMER][NEGATIVE] I don't know if they bother to me.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, so, um, is that something you guys can call them or?
[AGENT][NEUTRAL] No, they you, they will have to call us. We can't call out to anyone.
[AGENT][NEGATIVE] I don't even see where someone called to verify your benefits, but you can call them on a conference call if you would like because they just literally told you some inaccurate information because here in the American Public Life, when we go into a policy, we have to make notations of it and no one called here for you on your behalf and since [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh wow, OK, so yeah, let me put her on the line just a minute.
[AGENT][POSITIVE] Sure, no problem.
[CUSTOMER][NEUTRAL] Hello [PII]?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, I'm here.
[CUSTOMER][NEUTRAL] OK, so I have [PII] um on the phone, so this is probably gonna be a matter that I should transfer to insurance so that they can better assist. I'm just scheduling so I don't wanna, you know what I mean, I don't wanna have to um.
[CUSTOMER][NEUTRAL] Yeah, so let me get you over to an experience and really quick, OK.
[AGENT][NEUTRAL] So who told you about the insurance? Her or someone else?
[CUSTOMER][NEGATIVE] It's not.
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] How?
[CUSTOMER][NEUTRAL] [PII] told me about it when I asked her uh her listed on the demographic sheet so I can see both Blue Cross as the primary American public as secondary. I see both member IDs, um, and I'm showing that the deductibles have not been met for, um, Blue Cross Blue Shield, which is the primary.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And yeah.
[CUSTOMER][NEUTRAL] I don't know, I don't know much more than that. I don't have enough information in front of me because I'm not insurance but.
[CUSTOMER][NEUTRAL] So, um, that, um, American Public is my gap, and they, uh, she said I have outpatient coverage.
[CUSTOMER][NEUTRAL] OK, well, uh, let me get you over to insurance because like I said they can better assist. I'm not sure if sleep studies are considered outpatient or how that goes or you know the technicality. So if you don't mind giving me a moment, let me get an agent that can better assist you, OK? OK, thank you. You're welcome.
[CUSTOMER][POSITIVE] Alrighty I'm gonna transfer you over now.
[CUSTOMER][POSITIVE] Thank you. You're welcome.
[CUSTOMER][NEUTRAL] Hi [PII] speaking.
[CUSTOMER][NEUTRAL] Yes, hi, [PII]. Um, my name is [PII]. Um, I was calling in regards to my coverage, so I just spoke to, um, well, I have her on the line, [PII] from [PII] Perfect Life. So she, she, she looked and she said there's no, no one has verified my, um, gap insurance, but they do, I do have coverage. Yeah, we didn't, we didn't have it, um, they, I guess who did the intake, they just got the Blue Cross insurance.
[CUSTOMER][NEUTRAL] I gave them both. I provided both and [PII] just told me that she does have it.
[CUSTOMER][NEUTRAL] OK, I didn't have it on the paper that I, I was going off of. I'm in the insurance department.
[CUSTOMER][NEUTRAL] So can you verify that member ID number for me?
[CUSTOMER][NEUTRAL] So now what I wanted to ask you is the sleep study considered um outpatient benefits right? or in the hospital benefits since it's at a facility.
[CUSTOMER][NEUTRAL] It's outpatient benefit. OK, so the um the member ID is 02473340 M as in Mary, L as in Larry, the number 8.
[CUSTOMER][NEUTRAL] OK, 02473340 ML 8.
[CUSTOMER][NEUTRAL] So it's 02 02473340 ML 8.
[CUSTOMER][NEUTRAL] And you say she your insurance they're on the phone?
[CUSTOMER][NEUTRAL] Yes, Silla.
[AGENT][NEUTRAL] Yes, I'm here.
[CUSTOMER][NEUTRAL] Hi, so, um, if I give you the procedure code or the benefit code, would you be able to give me exactly um what is covered?
[AGENT][NEUTRAL] So we don't need that here at American Public Life because we are gap insurance as expressed to the insured. However, her policy has outpatient benefits of $300 per calendar day to assist with her deductible, co-pay and co-insurance for the primary, and this is not a guarantee of benefits, just a disclaimer of the policy's coverage. As long as her if the sleep study is taking place in a diagnostic setting, diagnostic testing setting, then it's considered as outpatient and then falls under her outpatient benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and that is she's covered just $300 of that?
[AGENT][NEUTRAL] $300 per calendar day.
[CUSTOMER][NEUTRAL] OK, so each day she's granted $300.
[AGENT][NEUTRAL] Yes, that is correct. And then she has inpatient benefits of $3000 per year, and this is not a guarantee of benefits, just a disclaimer of the policy's coverage, but inpatient is considered as 18 hours or more.
[CUSTOMER][POSITIVE] Good
[CUSTOMER][NEUTRAL] OK, alright, just to make it clear, so the balance she had.
[CUSTOMER][NEUTRAL] With just the primary it was 5:47. Are you guys gonna cover that for her?
[AGENT][NEUTRAL] So if something went towards, so so this is, so here's the thing, ma'am, so I'm not sure so we both know because you work in billing and I work for the insurance company, so we both know that your facility may be in network with her policy so yes you may be submitting a claim for $1000 but we both know that the network fee, if there's a percentage if that provider is in network with this.
[CUSTOMER][NEUTRAL] Because you're saying 300 a day, but I don't know.
[AGENT][NEUTRAL] Her um policy, then there's gonna be a discounted rate, so it was not, it will not be that amount that you're actually submitting. It's gonna be a discounted rate. However, whatever goes towards this young lady's deductible co-pay or co-insurance, it will cover it up to $300 here in American Public Life. So once you receive that claim in that EOB from the primary, you will send that claim in that primary EOB here to American Public Life.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] All right. Um,
[CUSTOMER][NEUTRAL] Thank you, can I have a reference number?
[AGENT][NEUTRAL] I don't want anyone to be confused from this call, so please let me know if I need to elaborate more.
[CUSTOMER][NEUTRAL] Uh, I'm just, OK, if you can just give me one second, OK?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] All right, so I kind of got it now so um.
[CUSTOMER][NEUTRAL] $300 per calendar day. I'll just get a reference number.
[CUSTOMER][NEUTRAL] And but she also said there's an inpatient um benefits as well or how would she submit it um [PII] I mean [PII]. We're not inpatient, that's hospital. We're not a hospital, so we wouldn't even fall under the inpatient benefits. OK.
[AGENT][NEUTRAL] I don't
[CUSTOMER][NEUTRAL] OK, so since it's she's saying it's $300 per day, that $547 we would just take $300 from it so your balance would be the 247. OK.
[CUSTOMER][NEUTRAL] OK, but we do have like uh they could break it down for you where you pay 3 different times if that works out for you.
[CUSTOMER][NEUTRAL] Yeah, that'll work out.
[CUSTOMER][NEUTRAL] No, um, outpatient too, but we don't, we don't do the inpatient business, right? OK, yeah, so, um, I'm gonna go ahead and send you back to [PII]. Did you, did you wanna get scheduled now? No, she's already scheduled me. I just wanted to clarify everything before you know I got there.
[CUSTOMER][NEUTRAL] Oh, OK, um, so the [PII], that sounds OK for you?
[AGENT][NEUTRAL] Miss.
[CUSTOMER][NEUTRAL] Um, yeah, that's, that's OK. Um, and you say your name was [PII], I'm sorry.
[CUSTOMER][NEUTRAL] [PII]. Spell that for me, please?
[CUSTOMER][NEUTRAL] [PII] [PII]
[CUSTOMER][POSITIVE] [PII] OK, thank you.
[CUSTOMER][NEUTRAL] Alright, um, so you're already scheduled, you're set. They will call you a day or two before your appointment to confirm, OK? OK.
[CUSTOMER][POSITIVE] All right, Mr. [PII]. You have a great rest of your day and thank you, American Life.
[CUSTOMER][POSITIVE] Thank you. You too. Thank you. Bye bye.
[AGENT][NEUTRAL] Alrighty, is there anything else that I can assist you with today, Ms. [PII]?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No, and then, um,
[CUSTOMER][NEUTRAL] No, they just go ahead.
[AGENT][POSITIVE] Alrighty well thanks thanks for calling APL and have a great day.
[CUSTOMER][NEUTRAL] No, that, that'll be all.
[AGENT][NEUTRAL] Goodbye.
[CUSTOMER][POSITIVE] You too thanks bye.