AccountId: 011433970860
ContactId: 2beb3ff6-a7d0-4352-b8d9-81e50431be90
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 401200 ms
Total Talk Time (AGENT): 215032 ms
Total Talk Time (CUSTOMER): 138748 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/12/2beb3ff6-a7d0-4352-b8d9-81e50431be90_20250612T14:35_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATM. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] So I was calling, good morning, how are you? I was calling to get a better understanding of what my benefits are.
[CUSTOMER][NEUTRAL] And then, how do I go about um
[CUSTOMER][NEUTRAL] I submit any any claim.
[AGENT][POSITIVE] Yes, ma'am. I can assist you with your benefits. Um, first, can I get your name and a good callback number?
[CUSTOMER][NEUTRAL] Uh, my name is [PII].
[CUSTOMER][NEUTRAL] Um, my number is [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII]. Now, can I get your policy number, please?
[CUSTOMER][NEUTRAL] Um, 026.
[CUSTOMER][NEUTRAL] 14413.
[AGENT][NEUTRAL] OK, thank you. Now, please verify your date of birth and your mailing address.
[CUSTOMER][NEUTRAL] Uh, date of birth is um [PII]. My mailing address is [PII].
[AGENT][NEUTRAL] OK, and please verify your email address.
[CUSTOMER][NEUTRAL] Um, it should be [PII].
[AGENT][NEUTRAL] OK. Yes, ma'am. And I'm showing that this is a policy for secondary gap insurance. Um, what we do is cover the co-pay, the co-insurance, and the deductible after your primary insurance processes a claim up to a certain amount and for certain benefits. Um, for which benefit, um, are you calling to?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Verify.
[CUSTOMER][NEUTRAL] Um, so would you just name with three different ones you said cover the co-insurance, covered the.
[CUSTOMER][NEUTRAL] What was the rest?
[AGENT][NEUTRAL] The co-pay and the deductible?
[CUSTOMER][NEUTRAL] Copay.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I think this will be um coverage for the the deductible.
[AGENT][NEUTRAL] OK. Yeah, for, I'm showing that there's coverage for services provided in the urgent care facilities. Um, if you visit an urgent care facility, we'll cover up to $250 per visit.
[AGENT][NEUTRAL] And again, that's for the co-pay, the co-insurance, and the deductible after your primary insurance submits the claim. And actually for all outpatient services, um, including services such as outpatient surgery or any services you have done at the hospital where you're not admitted, um, such as ER visits or, or again, outpatient surgery.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] We cover up to $250 per occurrence and per occurrence is every 90 days. So what would happen is that the um provider will bill your primary insurance company first and then the charges that go towards the copay, the co-insurance, and the deductible will cover it up to $250 every 90 days.
[AGENT][NEUTRAL] And um for inpatient services, if you're ever admitted, we'll cover up to $500 per admission, and that's for the co-pay, the co-insurance, and deductible after your primary insurance processes the claim. Um, but unfortunately, I'm showing that there's no coverage for services provided um in doctor's office. So if you have a, an appointment, um, a regular doctor's office appointment, there's no coverage.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got you, um, so I guess my, I'm having a procedure on Monday, and so they have my insurance like did the claim and so they wanted me to do a prepayment, which I, I have done, will be the best way to submit, do I submit the claim? Do I submit the receipt for me paying the.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Prepayment, I don't know what's the, what should I do?
[AGENT][NEUTRAL] Yeah, in order to file a claim, it sounds like for outpatient surgery, um, we'll need the explanation of benefits from your primary insurance company. So the claim would have to go through your primary insurance first. We'll need the explanation of benefits for the service and we'll also need your diagnosis code and it would have to come from your provider. So it can come from your provider's office or either the facility where you're having the procedure done.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And it's um a diagnosis code letting us know why you're having the surgery. And that's all the information we'll need and you can either fax us the information or you can file the claim online. Um, have you been to our website and set your policy up online?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I think I have, but I was never really sure how this works, um.
[CUSTOMER][NEUTRAL] So I'll try to log in.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Once I get off the call to make sure, but it'll, I'll probably do it online. It sounds like an easier option than fax it for me.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, and um recently we've updated our system. So if you've um set your policy up before, you, you're probably gonna have to set your policy up again. So when you go to our website, make sure that you, if you're not able to log in, make sure that you click on create um new policy online and you should be able to set your policy up online and log in.
[CUSTOMER][NEUTRAL] And so I just
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, sounds good. So I'll just submit the explanation of benefits, a diagnosis code. Do I verbally get that from them or is there somewhere on some paperwork?
[AGENT][NEUTRAL] Um, it's on some paperwork. Sometimes it'll be on your statement, but normally what you would have to do is get a letter from them.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Or some type of documentation from them. It has to come from the provider's office with your diagnosis code.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'll look in my chart and they may have sent me something. I just wasn't aware what it was to finder's office.
[CUSTOMER][POSITIVE] OK, I think that's all the questions I have. Thank you so much for your help.
[AGENT][NEUTRAL] OK. Is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] No, not today. Have a great day.
[AGENT][NEUTRAL] You do the same, [PII]. Thank you for calling ATL. Mm bye. Mhm.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yeah