AccountId: 011433970860
ContactId: 2f6fbb53-9613-490a-a0b1-e2dd703ebd3d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 361809 ms
Total Talk Time (AGENT): 181933 ms
Total Talk Time (CUSTOMER): 162843 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/2f6fbb53-9613-490a-a0b1-e2dd703ebd3d_20250203T18:37_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hi, I have a question regarding um my benefits.
[CUSTOMER][NEUTRAL] Um, should I give you my, should I give you my name and information, or?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes please can I get your name and your phone number first?
[CUSTOMER][NEUTRAL] Sure, my name is [PII] and my phone number is [PII].
[AGENT][NEUTRAL] Thank you, Ms. [PII]. And then what is your policy number?
[CUSTOMER][NEUTRAL] OK. Um, 02538149 and then there's ML 7.
[AGENT][NEUTRAL] OK, let me
[CUSTOMER][NEUTRAL] Also ML or outpatient I guess there's inpatient.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Yes, you're correct. Let me pull in your policy real quick, Ms. [PII].
[AGENT][NEUTRAL] Um, can you verify your date of birth for me?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Sure, it's uh [PII].
[AGENT][NEUTRAL] Thank you and then I'm also going to need for you to verify your address, phone number and email address that we have on the policy for you.
[CUSTOMER][NEUTRAL] Sure. My address is [PII]. My email is my first and last name, [PII].
[AGENT][NEUTRAL] OK, it looks like I have your work email address.
[CUSTOMER][NEUTRAL] [PII], right? Does it the work set up.
[AGENT][POSITIVE] Thank you.
[AGENT][POSITIVE] I appreciate you verifying your policy for me. So you said you have some questions about your benefits. How can I help you with that?
[CUSTOMER][NEUTRAL] So my son has to have an MRI done and um.
[CUSTOMER][NEUTRAL] I will I received the call from the radiology place telling me like, oh, I've given them my primary insurance and they said that I had to pay like $400 out of pocket for the MRI.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm, mhm.
[CUSTOMER][NEUTRAL] And I forgot to give them this card, so I just gave it to them, um, but I wanted to know if those, if that would be covered, um, if that those if that would be covered under your under this policy.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I understand, and this is just to verify your coverage, it's not a guarantee of payment. Your policy is a supplemental insurance policy that is billed secondary to the primary.
[AGENT][NEUTRAL] Um, so it's billed second, you are correct about that. It does help with your deductible, your co-pay, or your co-insurance. Uh, you have an outpatient.
[AGENT][NEUTRAL] Per calendar day benefit amount of $250 to go towards that deductible co-pay or co-insurance. And it does um cover an MRI imaging center.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Perfect. Alright, so that's what I wanted to know. So how does it work? Do I pay them the $400 and then submit the claim with you guys, or do they do that? and then.
[CUSTOMER][NEUTRAL] How how or what's because I really need the MRI done sooner than later, um, uh, so.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] They also, because my insurance, they're still waiting for my insurance to approve it to give them the prior off.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um, she also offered if I went out of pocket, if I go out of pocket, would you, would, would, um, this policy, uh, reimburse me for whatever I paid like the 250?
[AGENT][NEUTRAL] So what happens is, is if the insurance company files the claim for you.
[AGENT][NEUTRAL] Then the benefit would go to them, the 250 would go to them. If you file the claim yourself after paying, you would have to get your explanation of benefits from your pri primary insurance carrier and you would have to get your um itemized statement with your procedure and diagnosis codes on it along with the claim form and then you could file the claim yourself and then the deductible would be paid.
[AGENT][NEUTRAL] To you, um, that you can contact the MRI imaging center, let them know that you have this policy, and it covers $250 per calendar day for deductible co-pay or co-insurance. Let them know. They may not, um, I don't know how their procedures are, but usually if they can verify the coverage, they won't even charge you and they'll file it with us.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] But you can ask them, you know, if, if they want to file the claim for you and if they need to call and verify your benefits, they can call the same number you did and we can verify your benefits over the phone with them.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Perfect. OK, perfect. Alright, so uh that's what I'm gonna do, um, I'm gonna, I'm gonna contact them and ask them. I appreciate your help. Thank you.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're very welcome and I hope that everything goes good with your, with your son's MRI and everything as well. We appreciate you calling ATL.
[CUSTOMER][POSITIVE] OK great thank you so much.
[AGENT][POSITIVE] You're welcome, Ms. [PII]. Bye-bye.
[CUSTOMER][NEUTRAL] OK, bye bye.