AccountId: 011433970860
ContactId: 18de18ad-92dd-46ba-a03d-ff84e2d9dbd3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 918159 ms
Total Talk Time (AGENT): 435470 ms
Total Talk Time (CUSTOMER): 403484 ms
Interruptions: 3
Overall Sentiment: AGENT=1.3, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/18de18ad-92dd-46ba-a03d-ff84e2d9dbd3_20250514T14:00_UTC.wav
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[AGENT][NEUTRAL] My name is [PII]. How may I help you?
[CUSTOMER][NEGATIVE] Hey, I have a really bad connection. Did you say your name is [PII]?
[AGENT][POSITIVE] Yes, I'm sorry. Uh, yes, my name is [PII]. Thank you for contacting ATL. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, the connection's awful, but I'm, I'm hearing most of what you're saying, so I have his name is [PII] on the other line. He's the policyholder. He has a gap plan through his wife's employer. Um, he does have an upcoming MRI coming, so we're the MRI facility does have the gap plan card on file, but they're still saying that he would owe the $250 copay, which is his copay for MRIs for the on his medical plan. So we're just trying to figure out how you guys will come in and how to make claims and stuff.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes, I can certainly help with that. And um uh what is [PII]'s, uh, what is the policy number?
[CUSTOMER][NEUTRAL] Um, I'll bring him on. I don't have that. Give me one second.
[AGENT][POSITIVE] OK, thank you, thanks.
[CUSTOMER][NEUTRAL] You're welcome, [PII].
[CUSTOMER][NEUTRAL] Yep. Hey, thanks for holding we're on the line with [PII] do you have your policy number on that card?
[CUSTOMER][NEUTRAL] I do so.
[CUSTOMER][NEUTRAL] Let me find it. So is that the payer ID group number? What, what should I be looking for?
[AGENT][NEUTRAL] The outpatient benefits?
[CUSTOMER][NEUTRAL] Uh, outpatient benefit certificate number, yep, so it's 023.
[CUSTOMER][NEUTRAL] 467.
[CUSTOMER][NEUTRAL] 65 M as in Mary, L as in L 8.
[AGENT][NEUTRAL] OK, [PII], while I'm looking this up, if I could get um.
[AGENT][NEUTRAL] I just need to verify your last name.
[AGENT][NEUTRAL] A date of birth and a phone number, please. I just want to make sure I'm getting the right policy.
[CUSTOMER][NEUTRAL] Understood if you want my my information or my wife's information who is on the card?
[AGENT][NEUTRAL] No, I'm, I'm gonna get your information since you're on the policy, and I just need your last name, your date of birth, and a phone number, please, sir.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Last name [PII]
[CUSTOMER][NEUTRAL] Date of birth [PII].
[CUSTOMER][NEUTRAL] Phone number [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you very much. I'm just looking that up now. So the um outpatient benefits for uh that type of service.
[AGENT][NEUTRAL] We would take up the deductible, co-payment or co-insurance up to $500. Now you're telling me that the MRI facility is, is still wanting to charge you $250?
[CUSTOMER][NEUTRAL] Yeah, even with the APL policy on file.
[AGENT][NEUTRAL] OK, are, are they telling so we need to find out first, usually there's there's a couple of different reasons why they would do that.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] What did they tell you how much the MRI would cost?
[AGENT][NEUTRAL] After they, after they file through major medical. They are going to file through your major medical, is that correct?
[CUSTOMER][NEUTRAL] Yes, they like through Cigna, the the insurance you're talking about?
[AGENT][NEUTRAL] Yes, and so after they file through Cigna, did they tell you how much would be remaining of the balance?
[CUSTOMER][NEUTRAL] So it's 250 Yeah. And the, the co-pay on the plan for MRI's is a straight flat fee of $250 so they're charging in the full copay of $250 for the MRI.
[AGENT][NEUTRAL] I understand. OK. So the only thing that I can think of because because normally what will end up happening in this case, we will cover that. We will cover up to $500 per calendar day.
[AGENT][NEUTRAL] Um, for an MRI, that is one of the things that your policy is, is meant to do, uh, with the outpatient benefits. So for, for an MRI, there, there should not be a problem. They would file normally, they would file through Cigna.
[AGENT][NEUTRAL] Then they would fall through us and we would pick up that that out of pocket.
[AGENT][NEUTRAL] Uh, cost so that you would not have to pay anything. The only thing that I can think of, and you may want to check with the MRI, uh, um, facility.
[AGENT][NEUTRAL] The only other thing that I can think of is that they don't want to file your secondary insurance, and that they would rather that you file the claim yourself. So one way or the other.
[AGENT][NEUTRAL] 11 way or the other is
[AGENT][NEUTRAL] If Cigna is, is, is, uh, leaving a deductible co-payment or co-insurance of $250.01 way or the other, Evan, we, we will get that we can get that benefit paid now whether the MRI facility files the claim or whether you do.
[AGENT][NEUTRAL] We can pay that $250 benefit, but it sounds like the like the like the MRI, uh, facility, even though they have your, your, uh, secondary insurance, sometimes they don't want to file it, um, just because maybe they don't have the person, the, uh, the facility, the the personnel to do it it could be any number of reasons.
[AGENT][NEUTRAL] But, but it is covered.
[AGENT][NEUTRAL] This is the sort of thing that your secondary insurance is meant to do for you, is to cover just this sort of thing.
[CUSTOMER][NEUTRAL] Got you. So [PII], it sounds like one, now that you're armed with more information and you can guarantee that the plan will pay up to $500 you can tell them, you know, they would just bill it as a normal secondary insurance, so billing your they should know what that means, billing signa first and billing this one as a secondary. If they refuse, then it's unfortunately gonna be your burden to submit that claim.
[CUSTOMER][NEUTRAL] Is that is that clear so far? 100%. How do I sounds like they, they won't take that burden on of running the secondary insurance because they claim they already have, so how would I go about filing that? Well, they haven't ran it though that's the thing though because you didn't even get the services so basically once you get the services they would build Cigna. Cigna would process it minus the $250 then once they get that you'll be back from Cigna, then they can file to the secondary.
[CUSTOMER][NEUTRAL] I don't know if it was ever confirmed, you know, if they would file the claims they're just saying hey we pre verified your benefits and this is what we came back with.
[CUSTOMER][POSITIVE] Um, so now this is a new ask which is hey this is 100% what I have. Can you build this as a secondary? hopefully they'll just say yes, uh huh.
[CUSTOMER][NEUTRAL] So what everything as of now if I wanna go for my MRI I would pay the 250 and then they would bill the secondary insurance. That would be their discretion if they say they might say, OK, best case scenarios they'll say OK no problem you don't owe us anything we'll bill [PII] we'll bill your secondary we'll bill you if there's anything left over, and there shouldn't be.
[CUSTOMER][NEUTRAL] Worst case scenario is, no you owe your, your, you owe your 250, we'll give you the documents that you need. You're gonna have to submit the claim on your own and then um then you would get reimbursed directly from APL and I'm sure [PII] can go over you with the claims filing instructions are. I don't know if you wanna talk to the MRI place first to see what they're willing to do.
[AGENT][POSITIVE] Yes, absolutely.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][MIXED] Sounds like a plan, but yeah, if possible, just if I can get break down how I would reimburse it just while we got you on the phone, that would be great for the worst case.
[AGENT][NEUTRAL] It, it
[AGENT][POSITIVE] Yes, they can certainly they can certainly um.
[CUSTOMER][NEUTRAL] Uh, [PII], he said
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] He said, um, I guess just to cover all bases if you can go over what the claims filing instructions is just case worst case scenario he doesn't need to submit his own claims.
[AGENT][NEUTRAL] Yes, of course, I can help with that. So, um, [PII], um.
[AGENT][NEUTRAL] You'll have your explanation of benefits from Cigna.
[AGENT][NEUTRAL] Showing a deductible co-payment insurance.
[AGENT][NEUTRAL] And you will also need documentation from your provider or from the MRI.
[AGENT][NEUTRAL] Facility
[AGENT][NEUTRAL] Letting us know what the charges are for the MRI.
[AGENT][NEUTRAL] And why? Now there's the um why you're having an MRI. Now that is, it is called a, a diagnosis. It's basically why are you going in for an MRI and you will get that from your provider. Uh, if your doctor is suggesting that you go get an MRI, he can, there are walkout notes that they will give you that will show this is the diagnosis, this is the reason why we're asking you to get the MRI. So that, so those are the things that we will need.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] And we have several different ways of uh filing a claim with us. Probably the fastest way is going online. Now, on your card.
[AGENT][POSITIVE] Um, and I'm glad you have your card there. You will see where we have a website.
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And what you would do is you would go on our website.
[AGENT][NEUTRAL] Um, there's a place where it says sign in and then you would sign in as a new user if you haven't already built a a account with us.
[AGENT][NEUTRAL] And you can submit all the documents that way and when you're when you have all those gathered together, if you would like.
[AGENT][NEUTRAL] Um, normally what we suggest is have people, you know, you can call us and we will walk you through the process.
[AGENT][NEUTRAL] And we usually will receive the claim, you know, uh, immediately, and, um, then, uh, what we do is it takes 8 to 10 business days, sometimes less to file that for us to process that. But if you file the claim yourself, the benefit will be paid to you. So one way or the other.
[CUSTOMER][POSITIVE] Awesome.
[AGENT][POSITIVE] Whether the MRI place filed it, whether you file it, you know, we can try and get this this taken, you know, get you reimbursed or get it paid for one way or the other. You can also have the MRI company call us and we will be glad to give them the benefits. Now I'm trying to see whether on our notes we do make notes of all the calls that we have, um.
[AGENT][NEUTRAL] I'm not showing, uh, let's see if I can't see it. Yeah, I'm not showing that the MRI company has ever contacted us regarding your benefits. And so, um.
[CUSTOMER][NEUTRAL] Yeah, that's what I was thinking.
[AGENT][NEUTRAL] So if they want to they can contact us and we will go over the same thing with them that we go with that we'll go over with you. Uh, they can also submit claims online, you know, it's a, it's, it's an easy process if they want to do it.
[AGENT][NEUTRAL] Um, so if you want to have the MRI company, yes, sir?
[CUSTOMER][POSITIVE] Perfect I that all with the.
[CUSTOMER][POSITIVE] No, no, I think that's great. I will definitely give them a call immediately and see if they can give you guys a call.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And [PII]
[CUSTOMER][NEUTRAL] Yeah. [PII], and a third option too is and it's kind of in the middle if they say, OK, well like you could pay them the 250 if they're still willing to file for you and then you can get reimbursed directly from them you know I'm saying it's kind of like a middle ground it's like look I'll pay the 250 if you don't get paid fine but if you get paid they will if you if you get paid then it might be easier for you just to get reimbursed from them then as opposed to you submitting all that paperwork.
[CUSTOMER][NEUTRAL] Got it and they yeah they just kind of canceled the charge.
[CUSTOMER][NEUTRAL] Uh, not cancel it but refund you, basically, yeah, because you, you would pay out of pocket day of, they would, you know, submit the claims, get payment, and then issue you a refund.
[CUSTOMER][POSITIVE] Awesome, just a couple quick questions just based off of the whole process. What explanation of benefits from Cigna, um, what exactly is that so I make sure I, I have the right things.
[CUSTOMER][NEUTRAL] Yep, you get those automatically in the mail. Have you ever gotten, um, like a little chart after you have a service that you owe money from that shows where you went, the date of service, the, uh, build amount.
[CUSTOMER][NEUTRAL] Got it that that's just based off of once I get that from Cigna for this MRI. Yeah, it's gonna take some time because you can't file the claim with APL until you have the explanation of benefits, which means you have to wait for the MRI place to billigna has to receive it, process it, and then issue out that EOB. You can also access them online as well um but it really depends on how quickly this MRI facility, you know, actually builds.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Got it. OK, awesome. So the two things that I need are very clear now and then just the, the last question, [PII], just because the, the website you gave me what I think was a little different than what I'm seeing on my card, on my card it says to check claim status or view EOBs right at uh [PII]. Is that that's different than the website you just gave? Can I get the
[AGENT][NEUTRAL] It, that'll get you to the same place.
[AGENT][NEUTRAL] Yeah, that's it, that'll get you to the same place absolutely and when you go online, um, when you go online, uh, it will say workforce benefits that work for you, but on the right hand side it says sign in.
[CUSTOMER][POSITIVE] Oh perfect awesome all set.
[AGENT][NEUTRAL] And um that's when you're going to you're going to create a an account and you know if you haven't done something like that for Cigna uh you may want to do I'm sure that Cigna is online you say is online as well any time that you can go in on these sites and, and, uh, you know, just take the password and a and a a username, um, then that way you can see the process of your of your claim and you can also get these EOBs that we're talking about so um.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][POSITIVE] You can it's always a good idea and it it only takes a few moments, you know, just username password just put in some simple information and that's where you're going to, uh, file it. Now I can also give you our mailing address and our fax number, but that should also be on that card. But I, I think your fastest bet if, if you, if you are comfortable sending it through the, through, uh, electronically, I think that's the fastest way that we can.
[AGENT][POSITIVE] Do that and I was also going to tell you that if you wanted to start submitting your claims yourself, we also have a direct deposit um you know that way we can get the benefit to you just that much faster so whatever it is that you decide to do, um, just contact us we wanna make sure that you're using your secondary insurance and it you know if there's if if it's a covered benefit, we wanna make sure that we get that to you. So, um, whatever it is you decide to do, just, just let us know.
[AGENT][POSITIVE] And that we will try and help as much as we possibly can.
[CUSTOMER][POSITIVE] Amazing. I, I really appreciate you both and all this information. I will definitely give the imaging center a call right now and see if they can um and and I'm sorry, what, what, how should I phrase it? have see if they could run. Bill it as a secondary insurance so just fill the gap plan as a secondary insurance.
[CUSTOMER][NEUTRAL] Got it. But you know, start with also, you know, I just got off the phone with the gap policy they're guaranteeing they will pay up to $500 you would just need to submit the claims just kind of put it out there like that and see what they say.
[CUSTOMER][POSITIVE] Awesome. And then I'll let them know that they can give you a call if if needed. Yeah, do you need um the phone number? It should be on the card that ends in [PII] do you see that? Yeah, the, the [PII] number I got I got it. OK, perfect. Alright, did you have any other questions for me or [PII]? That's it for me now thank you both so so much. Yeah, thank you [PII].
[AGENT][POSITIVE] OK, well thank you for contacting ATL. You have a very good day.