AccountId: 011433970860
ContactId: fb3f0e00-eada-403a-b0b7-4339b882b682
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 365459 ms
Total Talk Time (AGENT): 149667 ms
Total Talk Time (CUSTOMER): 156170 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/18/fb3f0e00-eada-403a-b0b7-4339b882b682_20250618T22:23_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]. Um, I'm calling on behalf of uh one of your members, well, not on behalf. I'm trying to try to get benefits, uh, coverage. So we're from a medical office. Um, he has a, um, a card, uh, from APL.
[CUSTOMER][NEGATIVE] And he wants to see us tomorrow for an office visit, but we're not able to verify anything, not even through the website, through the multi-plan, nothing. So I was wondering if I can get any help. I was trying to choose the right options, but nothing was going through. I mean nothing was
[CUSTOMER][NEUTRAL] For medical offices like dental, and then like medi something then hospital and stuff like that. So I don't know if he has any coverage for primary care.
[AGENT][NEUTRAL] OK, may I have your name and then a callback number?
[CUSTOMER][NEUTRAL] Yeah, this is uh Doctor [PII]
[AGENT][NEUTRAL] OK, that's your name?
[CUSTOMER][NEUTRAL] My, my first name is [PII]
[CUSTOMER][NEUTRAL] Last name [PII], and I'm the doctor that's trying to verify his insurance.
[AGENT][NEUTRAL] OK, and may I have a callback number?
[CUSTOMER][NEUTRAL] Uh this is just for tonight because this is my personal number if you're gonna call me back tonight, um, but if not I have to give you my office number.
[AGENT][NEUTRAL] No, I'm just, I'm just needing a callback number for notation.
[CUSTOMER][NEUTRAL] Alright, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And may I have the policy number listed on the card?
[CUSTOMER][NEUTRAL] It it says 026.
[CUSTOMER][NEUTRAL] 22774
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, [PII] and the date of birth I'm opening the chart, uh, [PII].
[AGENT][NEUTRAL] OK, so this member has a hospital indemnity plan. Let me pull that up for you.
[AGENT][NEUTRAL] And you're calling in for eligibility for this member?
[CUSTOMER][NEUTRAL] Yes, but it's for a primary care visit. So like, I guess he's wanting to see me for primary care purposes, so I, I don't know. Like I said, the, the options weren't about primary care like hospital.
[AGENT][NEUTRAL] Yes, that is the, the options are for the choices of our products, which is Meigap Hospital Indemnity Dental, that is the listing and this member is a hospital indemnity member.
[CUSTOMER][NEUTRAL] Meaning what though I don't, I'm not familiar with that so I don't know what that means.
[AGENT][NEUTRAL] This is just, this is their medical insurance. So we just have different names. So when the card says indemnity or benefit in a car, that would be the option that you would choose.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] So I don't have none of that is there. So what I have on, cause I have a card, it's literally says American Public Life, the group name, the insured, the coverage, uh, policy number, effective date, plan, limited benefit, med plan, VIP VIC medical ID. So again, none of those options were given.
[AGENT][NEUTRAL] Limited benefits.
[AGENT][NEUTRAL] That's the hospital indemnity, which is the limited benefit plan.
[CUSTOMER][NEUTRAL] Say that again.
[CUSTOMER][NEUTRAL] So again, I wouldn't have known that from, I mean, limited benefit to hospital identity. I wouldn't have known that. So, um, that's fine and then.
[CUSTOMER][NEUTRAL] Uh, OK, so what's the next step?
[AGENT][NEUTRAL] You're needing the benefits for a physician, correct?
[AGENT][NEUTRAL] And the eligibility.
[CUSTOMER][NEUTRAL] Well, right, for primary, yes, for primary care.
[AGENT][NEUTRAL] Uh, for this policy, it is showing that it's currently active with the effective date of [PII] or 25. For physician office, verification of coverage does not guarantee the payment of the claim. This member does have up to $50 per day with a maximum of 4 days per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Once that $50 is paid, that is the maximum amount that we will pay out if there's anything left over, it is considered patient's responsibility.
[CUSTOMER][NEUTRAL] So essentially, he can, he would be responsible for anything over [PII], correct?
[AGENT][NEUTRAL] That is correct. Now, you may have to contact Benefit in a car as well to verify benefits with them. We handle the medical side. If there's any other benefits that they possibly could pay, they may give you the benefits for that as well.
[CUSTOMER][NEUTRAL] And who's that again?
[AGENT][POSITIVE] That is benefit in a car.
[CUSTOMER][NEUTRAL] I have no idea who that is.
[AGENT][NEUTRAL] Um, I can give you the number for you can, you can contact them.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah, go ahead and give me the number.
[AGENT][NEUTRAL] OK, so that number for benefit in a card is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And I'm gonna give you the num if you see down at the bottom where it says medical ID that starts with the letter [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That will be the number that you would give them to verify the benefits.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And is there anything else that I can assist you with today, [PII]?
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][POSITIVE] No, that's it. Thank you so much.
[AGENT][POSITIVE] You're welcome. Thank you for calling American Public Life. Have a great day.