AccountId: 011433970860
ContactId: fab33618-0443-402a-bc6f-2e025026f7bd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 472529 ms
Total Talk Time (AGENT): 164032 ms
Total Talk Time (CUSTOMER): 200979 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/fab33618-0443-402a-bc6f-2e025026f7bd_20250519T20:04_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, you're speaking with [PII] there.
[AGENT][NEUTRAL] Could you repeat yourself?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Yeah, my name is [PII]. Would you like me to spell it?
[AGENT][POSITIVE] Yes, it would be greatly appreciated.
[CUSTOMER][NEUTRAL] So my first name is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Last name is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Do you have a policy here at American Public Life?
[CUSTOMER][NEUTRAL] Yeah, but through my job.
[AGENT][NEUTRAL] Can I have a policy number?
[CUSTOMER][NEUTRAL] That's 02581689.
[AGENT][NEUTRAL] Thank you. Could you verify your mailing address, your date of birth, and your email address?
[CUSTOMER][NEUTRAL] So my mailing address is [PII].
[CUSTOMER][NEUTRAL] Date of birth [PII].
[AGENT][NEUTRAL] Thank you and what is your email address that we may have on file for you?
[CUSTOMER][NEUTRAL] That is [PII].
[AGENT][NEUTRAL] We have a different email address.
[CUSTOMER][NEUTRAL] Is it the [PII]?
[AGENT][NEUTRAL] It ends with selfie, but what is the words to it.
[CUSTOMER][NEUTRAL] So it's [PII].
[AGENT][POSITIVE] Thank you and what is a good call back number for you just in case the dial call is disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and how can I assist you today?
[CUSTOMER][NEUTRAL] So I recently received a bill from AC Florida Onemont Hospital. I did, uh, submit you guys, um.
[CUSTOMER][NEUTRAL] Insurance time the day of the visit, but it seems that they haven't run it through um anything. They forgot or missed it. So I was wondering how is the how do you guys cover um like the
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The remaining balance after the insurance is deducted.
[AGENT][NEUTRAL] Well, they will have to submit a claim here to us.
[CUSTOMER][NEUTRAL] Media deduction.
[AGENT][NEUTRAL] They will have to submit a claim here to us in regards to the services that you receive and once we receive it, it depends on the place of service.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then we go from there, but it looks like you have outpatient benefits of $250 per calendar day and that consists of.
[AGENT][NEUTRAL] Outpatient services of cancer rider, the lab, diagnosis, diagnostic testing, DME coverage.
[AGENT][NEUTRAL] There's a lot of different benefits that it comes.
[CUSTOMER][NEUTRAL] So it doesn't, it doesn't really, so does it cover for outpatient, does it cover for services just like um emergency room or something like that?
[AGENT][NEUTRAL] That is considered as outpatient.
[CUSTOMER][NEUTRAL] Yeah, so it would cover for that.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] In that case.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And you said my annual one is 250?
[AGENT][NEUTRAL] $250 per calendar day.
[CUSTOMER][NEUTRAL] The calendar day, what that means?
[CUSTOMER][NEUTRAL] Does that mean like
[AGENT][NEUTRAL] And then you have benefits coverage for up to $250 per day, say if your primary insurance company put something towards your deductible, co-pay or co-insurance that falls on the category of the services covered under your policy, then we will pay up to $250 per calendar day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so in this case where I have the 350, they will only cover 250 out of the 350 remaining 100 for me to pay, right?
[AGENT][POSITIVE] Yes, that is correct.
[AGENT][NEUTRAL] Yes, and this is not a guaranteed benefit it's just a disclaimer of the policy coverage.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][POSITIVE] Alright, thank you. I just wanted like uh is um just
[AGENT][NEUTRAL] So, did you see your primary ELB?
[CUSTOMER][NEUTRAL] The primary EOBs?
[AGENT][NEUTRAL] Yeah, did you, did you have it? Do you show what went towards your deductible, co-pay and co-insurance?
[CUSTOMER][NEUTRAL] What do you mean? Sorry, I'm just trying on understand. Sorry, what do you mean?
[AGENT][NEUTRAL] Um, when I, what I'm meaning is, did you, do you have an EOB from your primary insurance company like cause the provider may have charged you $600 however, but if they're in network there's gonna be a discounted rate. So once the primary insurance company processes the claim, there's gonna be an EOB.
[AGENT][NEUTRAL] Which is the explanation of benefits showing how the claim was paid and there's gonna be an amount that went towards your deductible, co-pay or co-insurance if there's out of pay, if you're out of pocket out of pocket amount has not been met.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Um, let me see.
[CUSTOMER][NEUTRAL] You know where I can go to see that?
[AGENT][NEUTRAL] I'm not sure cause I'm not affiliated with your primary insurance company.
[CUSTOMER][NEUTRAL] Cause the, the primary insurance company um.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][POSITIVE] I can go on the app real quick.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] So here,
[CUSTOMER][NEUTRAL] You be
[CUSTOMER][NEUTRAL] I don't go no more.
[CUSTOMER][NEUTRAL] No, I don't see anything about any EOB honestly.
[AGENT][NEUTRAL] So I'm not affiliated with your primary insurance company, so I'm not sure where you will find it at.
[AGENT][NEUTRAL] May have to reach out to your primary insurance company to verify where you would be able to locate it.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything, but you don't have any claims on file?
[CUSTOMER][NEUTRAL] But, um, and that
[CUSTOMER][NEUTRAL] In any case, I just, I just, um, I just sent in a claim through the, the hospital because I called the primary insurance about the bill and they told me that the remaining is what I'm supposed to pay based on, you know, and I should pay to the hospital itself.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] But they already, yeah, so I, I, I contact the hospital before I call you and I gave them again the APL inform my information from for APL and they're supposed to be sending that right now so.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So once the claim is received then it'll be processed.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] All right, thank you so much appreciate it.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] Thanks for calling APL and have a great day. Goodbye.
[CUSTOMER][NEUTRAL] All right bye.