AccountId: 011433970860
ContactId: f8229683-7786-4551-ad4d-f18e8fcc7d43
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 393119 ms
Total Talk Time (AGENT): 174531 ms
Total Talk Time (CUSTOMER): 153608 ms
Interruptions: 6
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/f8229683-7786-4551-ad4d-f18e8fcc7d43_20250106T20:08_UTC.wav
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[AGENT][POSITIVE] Thank you. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] So I'll get the notification I I.
[CUSTOMER][NEUTRAL] Hey there I'm trying to verify a patients um.
[CUSTOMER][NEUTRAL] Benefits
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And your name, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Are you the policyholder or you're calling on behalf of a provider?
[CUSTOMER][NEUTRAL] Provider.
[AGENT][NEUTRAL] OK, and how can I help you, [PII]? You said benefits, is this an office setting or outpatient facility?
[CUSTOMER][NEUTRAL] Outpatient um surgical center ASC.
[AGENT][NEUTRAL] OK, OK, and what's the policy number?
[CUSTOMER][NEUTRAL] It's 02030118.
[AGENT][POSITIVE] And a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] [PII]. Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And [PII], what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, [PII], his date of birth one moment.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][POSITIVE] Thank you
[AGENT][POSITIVE] Thank you for that information.
[CUSTOMER][POSITIVE] Mhm you're welcome.
[AGENT][NEUTRAL] We're checking eligibility and then outpatient surgery benefits.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so the policy effective date is [PII]. The policy is active at this time.
[CUSTOMER][NEUTRAL] Oh that is primary, uh huh go ahead sorry.
[AGENT][NEUTRAL] And the maximum outpatient benefit, well, the outpatient and inpatient benefit is combined for a maximum of $5000 per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then there's also an outpatient deductible of $100 that would need to be satisfied first.
[AGENT][NEUTRAL] And of course the information provided is verification, not a guarantee of payment, and I don't show any claims on file this year.
[CUSTOMER][NEUTRAL] OK, so the patient has primary Blue Cross. Are y'all acting as a secondary for them?
[AGENT][NEUTRAL] This plan is secondary and this plan will cover up to $500 per calendar year of covered charges or any amounts applied towards deductible, co-insurance, and or co-pay amounts.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Do you have the accruals or the accumulations on file?
[AGENT][NEUTRAL] No claims on file for 25.
[CUSTOMER][NEUTRAL] No claims on file.
[CUSTOMER][NEUTRAL] So that patient, so you say you'll cover up to 500?
[AGENT][NEUTRAL] 5000 per calendar year but the inpatient and outpatient benefit is combined.
[CUSTOMER][NEUTRAL] Per calendar year.
[AGENT][NEUTRAL] For max of 5000.
[AGENT][NEUTRAL] Per calendar year.
[CUSTOMER][NEUTRAL] OK, so what does the what does the patient need to meet on their primary in order for y'all to kick in?
[AGENT][NEUTRAL] What do you mean? Well, their calendar your deductible, I'm sure and so whatever is applied towards their major medical deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because
[AGENT][NEUTRAL] This policy will cover the deductible up to 5000.
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] Well, let me rephrase that.
[CUSTOMER][NEUTRAL] OK, because they're they have Blue Cross and with their Blue Cross plan they have an individual deductible of 5000 with nothing applied to that, so they need to cover the whole $5000 before y'all will kick in.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm. So when the, so if the primary applies the $5000 towards their deductible, you would submit the claim to American Public Life. Now they will have a.
[CUSTOMER][NEUTRAL] So it will be uh-huh.
[AGENT][NEUTRAL] A $100 deductible under our policy and once that's satisfied, then we will pay a benefit up to $5000.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Does that make sense?
[CUSTOMER][NEUTRAL] Kinda.
[AGENT][NEUTRAL] So, so the hypothetically.
[CUSTOMER][POSITIVE] The these kind of plans always get me all kind of mhm.
[AGENT][NEUTRAL] I know, so hypothetically, the primary because it's the new year will apply, I'm gonna say 5000 using your figure, uh, to the deductible.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, the, the benefit under our policy is, uh, a combined inpatient and outpatient benefit of $5000 per calendar year, but the patient would first have to meet our deductible which is $100.
[AGENT][NEUTRAL] So we would subtract.
[CUSTOMER][NEUTRAL] OK, so do we submit to you all first?
[AGENT][NEUTRAL] No, to your major to the major medical.
[CUSTOMER][NEUTRAL] To the major, OK, alright, I will try to get.
[AGENT][NEUTRAL] We're secondary.
[CUSTOMER][NEGATIVE] I will try to get this figured out because it's I don't know why it's sending me um.
[AGENT][NEUTRAL] What's happening?
[CUSTOMER][NEUTRAL] Uh, I don't know why it's confusing me because I see.
[CUSTOMER][NEUTRAL] And I know they're not responsible for the whole 5000 y'all come in, OK, so normally with these plans like a patient will have to meet 1000 before that secondary like your plan will kick in.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Like they'll have to meet $1000 on their primary before y'all kick in, but you're saying something about $100. I'm, I'm just confused. Hold on one second.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, both, both policies have a deductible. The primary deductible is $5000. Deductible with APL is only $100.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Not waiting just in the back like.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So when we receive the EOB and your itemized bill.
[CUSTOMER][NEUTRAL] Like there are um.
[CUSTOMER][POSITIVE] Yes, OK, and just when you see password then thank you I'm gonna do.
[AGENT][NEUTRAL] We'll apply $100 to our deductible. They would have satisfied that.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then apply benefits.
[CUSTOMER][NEUTRAL] OK, I might need you to speak to my administrator. That might help me. Maybe she can help me follow. OK.
[AGENT][NEUTRAL] OK, I will.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Hey, we're actually gonna trans transport a patient to the hospital. Um, I'll probably call back in the morning with her, OK?
[AGENT][POSITIVE] OK, no worries.
[CUSTOMER][POSITIVE] OK, thank you, bye bye. That'll be all. Thank you.
[AGENT][POSITIVE] Anything else? All right, [PII]. Thank you for calling ATL. Have a good day.
[CUSTOMER][NEUTRAL] Uh huh bye bye.