AccountId: 011433970860
ContactId: 1f415b5a-b37a-4dae-963e-011d6ff0d364
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 250830 ms
Total Talk Time (AGENT): 107404 ms
Total Talk Time (CUSTOMER): 134302 ms
Interruptions: 4
Overall Sentiment: AGENT=1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/1f415b5a-b37a-4dae-963e-011d6ff0d364_20250103T15:41_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, good morning, [PII]. I'm calling to um to verify my uh my coverage.
[AGENT][NEUTRAL] OK, you wanted to see if your coverage was still active, is that correct?
[CUSTOMER][NEUTRAL] Yes, I was trying to get online um and it's telling me it doesn't exist, so I just wanted to run it by you.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, absolutely I can help you with that. What is your name and your call number?
[CUSTOMER][NEUTRAL] My name is [PII]. It's under my husband's name, my husband's name, and he has it on family.
[CUSTOMER][NEUTRAL] My contact number is [PII].
[AGENT][NEUTRAL] OK, and what is the policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, the outpatient is 021-923-2.
[CUSTOMER][NEUTRAL] 2ML8
[AGENT][NEUTRAL] OK, let me look up that real quick.
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] OK, [PII], I do see that you are covered on the policy and the policy is active.
[AGENT][NEUTRAL] And your effective date for yourself is [PII].
[CUSTOMER][NEUTRAL] OK, and does this policy cover copayments?
[AGENT][NEUTRAL] This is, yes, it's a supplemental insurance policy that helps with deductible, co-pay, and co-insurance, and this is just to verify benefits. It's not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] But yes, that is what it, it helps with.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] OK, and then, um, because I wasn't sure if it was active, how far back can I go to submit claims regarding co-payments and such?
[AGENT][NEUTRAL] You can go back there's not a timely filing limit, so as long as the policy was active on the date of service you can send a claim in at any time.
[CUSTOMER][NEUTRAL] On.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] OK, and what is what I have to submit is would it just be the receipt?
[AGENT][NEUTRAL] No, ma'am, um, you'll have to send in the explanation of benefits from your primary insurance.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] and the
[CUSTOMER][NEUTRAL] They don't know that you know.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You'll also have to send in an itemized statement.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] From the physician's office?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That has the diagnosis and procedure codes on it.
[CUSTOMER][NEUTRAL] I think I have to meet [PII] in order to meet my kids.
[CUSTOMER][NEUTRAL] So that's gonna be the, the first major hurdle that we're gonna have to face because I think he's gonna be very.
[AGENT][NEUTRAL] And you'll also have to send in a claim form and I can give you the website to get the claim form.
[AGENT][NEUTRAL] That is
[CUSTOMER][NEUTRAL] OK, yeah, because I was, I was trying to to log in and then it was telling me to put in um.
[CUSTOMER][NEUTRAL] Let me see if I can go back.
[CUSTOMER][NEUTRAL] It wasn't my policy number. I think it's asking me for a different number.
[CUSTOMER][NEUTRAL] Then then the the number I just gave you.
[AGENT][NEUTRAL] Mhm. OK. Um.
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] A member ID number.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Right, Member ID number is actually the policy number.
[CUSTOMER][NEUTRAL] Oh, OK, because when I put it in, it's telling me it's wrong that it's not, it says not policy number, so OK, I just wanted to run that by you. So a statement with the with the code and procedure numbers.
[AGENT][NEUTRAL] Right, the itemized statement, and then the website you go to get the claim form is A like [PII].
[CUSTOMER][NEUTRAL] She could
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][POSITIVE] OK, thank you so much for your help.
[AGENT][POSITIVE] You're so very welcome. I hope you have a wonderful day. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] You too. No, that's all.
[AGENT][POSITIVE] OK, well you have a great day and thanks for calling APL Miss [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK thank you you too bye bye.
[AGENT][NEUTRAL] Mm bye-bye.