AccountId: 011433970860
ContactId: 1afad41e-897e-454d-a650-74f6755c4b06
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 671679 ms
Total Talk Time (AGENT): 243295 ms
Total Talk Time (CUSTOMER): 145612 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/1afad41e-897e-454d-a650-74f6755c4b06_20250528T18:21_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, I, I, hold on, sorry.
[CUSTOMER][NEUTRAL] I, I just had a question about um a bill that I have.
[AGENT][NEUTRAL] OK, I can help you with uh a question on your bill. Uh, what's your name and a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] My name is [PII], um, and then the number is [PII].
[AGENT][NEUTRAL] Do you have your policy number, [PII]?
[CUSTOMER][NEUTRAL] Yes, I believe it's 02462046.
[CUSTOMER][NEUTRAL] M as in Mary, L as in Larry, 8.
[AGENT][NEUTRAL] OK, give me just a moment.
[AGENT][NEUTRAL] Can I get you to verify your date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And your address and phone number that we have on file?
[CUSTOMER][NEUTRAL] [PII] and then [PII].
[AGENT][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] And was a question about a bill from us?
[CUSTOMER][NEUTRAL] No, it's, so I went to.
[AGENT][NEUTRAL] Hospital.
[CUSTOMER][NEUTRAL] Yeah, well, an orthopedic.
[CUSTOMER][NEUTRAL] Like sort of appointment um with the doctor. But I know that usually doctors visits aren't covered in my plan, but they did do X-rays, and I know that sometimes, I don't know if you guys consider that a procedure, so you cover some of it. Like my primary covered some of it, but there's still a little bit of a balance.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I was wondering if you would cover that in this instance or not.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Should I waste my time making the claim or?
[AGENT][NEUTRAL] OK, for X-rays?
[AGENT][NEUTRAL] Let me pull up your policy and see.
[AGENT][NEUTRAL] And you said your primary did pay partial correct?
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me pull it up, your policy up and see.
[AGENT][NEUTRAL] Give me just a moment while I look that up.
[AGENT][NEUTRAL] Cause I am showing you do have outpatient benefits, um, that includes surgery and diagnostic testing. Let me check and see. You said an MRI or an X-ray?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um, they have it listed as in, I believe an X-ray.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] I just, I'm just double checking to make sure. So give me just a moment.
[CUSTOMER][POSITIVE] I appreciate it.
[AGENT][NEUTRAL] I'm showing the only X-rays that are excluded are for dental and vision services.
[AGENT][NEUTRAL] I'm not showing that it isn't um isn't covered.
[AGENT][NEUTRAL] Let me double check.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] I am showing that MRI's are covered, but I wanna double check and see.
[AGENT][NEUTRAL] Because it does show diagnostic testing.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] This here
[AGENT][NEUTRAL] I would file for the claim because you said it was orthopedic.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, and that that would be under your outpatient benefits and if your primary did cover part of it, we might be able to pay partial, um, and this is just a verification of benefits and not a guarantee of payment, but you do have an outpatient benefit maximum of up to $3000 and that's per calendar day, uh, with a $0 deductible.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I am showing um certain surgery, surgery in an outpatient facility or free-standing outpatient center um because you said you had orthopedic surgery, correct?
[CUSTOMER][NEUTRAL] No, it wasn't a surgery. Like they were just like checking out my knee cause I was in pain and then they did an X-ray.
[CUSTOMER][NEUTRAL] To sort of see what was going on but no surgery yet.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But yeah, like I, I went to an orthopedic surgeon's office and he was like, yeah, I need to take an X-ray, see what's going on, and so that's what I'm getting a bill for.
[AGENT][NEUTRAL] OK, so it is, I mean, as long as it was within the diagnostic testing hospital or um as long as it wasn't, I don't know if you have an office treatment writer. So I would go ahead and file the claim, um, especially since your primary did cover partial. And when you file for that claim, you will want to include your primary's explanation of benefits or EOB, um, when you file for that claim.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You get.
[AGENT][NEUTRAL] And then again, when you have your surgery, if you, if it comes down to having a surgery, you'll want to file that too. Um, since this is secondary gap insurance, you will need to wait until the primary pays partial first.
[CUSTOMER][NEUTRAL] Of course.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then you can file the claim through us.
[AGENT][NEUTRAL] But I'm not showing that it's excluded unless it was for your vision or dental.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] Not sort of the, the big question. The easiest way to make the claim is just to go online, download the form and submit everything.
[CUSTOMER][NEUTRAL] Is it through email that I can submit it or?
[AGENT][NEUTRAL] Um, well, I do show that you have an email with us, so if you haven't, um, you can sign up for our online service center or you might hear it as an online portal account, um, you'll need to use the email that we have on file, um, but you can go to [PII] and from there you'll have you[PII] um.
[CUSTOMER][NEUTRAL] How does that work?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] ID cards are there, all of your policies, so the scheduled benefits that I I read to you, um, all of that will be in those policy documents that you can access online, um, and you can file a claim online as well.
[AGENT][NEUTRAL] And that's the that's probably the quickest way otherwise you can also fax it or you can uh send it through mail.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But the email isn't secure?
[CUSTOMER][POSITIVE] And it was secure.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That [PII].
[AGENT][NEUTRAL] [PII] public.
[CUSTOMER][NEUTRAL] What's the what?
[CUSTOMER][NEUTRAL] Public.
[AGENT][NEUTRAL] And you will need to use the email that we have on file because a lot of people will have maybe their work email and then they try to use a different email and it'll show them as not being found um and so you will need the email that we have on file do you know which one that is? Or can you verify that with me?
[CUSTOMER][NEUTRAL] Yeah, I believe it's the [PII].
[AGENT][NEUTRAL] Yes, so you will use that one to sign up.
[CUSTOMER][NEUTRAL] Yeah, I just gotta reset my password because I don't remember it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] Alright, I'll give you guys a call if anything, but thank you so much.
[AGENT][POSITIVE] Great, thank you for calling ATL and if there's nothing else I can help you with, have a great day.
[CUSTOMER][NEUTRAL] Or actually,
[CUSTOMER][NEUTRAL] Actually, yeah, um,
[AGENT][NEUTRAL] Oh, yes.
[CUSTOMER][NEUTRAL] I thought
[CUSTOMER][NEUTRAL] My email was my user name but I guess oh no, no, it is.
[CUSTOMER][POSITIVE] Alright, no, no, that was it thank you so much. I appreciate the help.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, did you get it fixed?
[CUSTOMER][POSITIVE] Yeah yeah I got it thank you so much.
[AGENT][NEUTRAL] OK, OK.
[AGENT][POSITIVE] Alright, well thank you for calling ATL. Have a great day.
[CUSTOMER][POSITIVE] Thank you have a good one.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] Bye.