AccountId: 011433970860
ContactId: 412d2cc6-8593-46fd-bbde-874023022299
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 538739 ms
Total Talk Time (AGENT): 360567 ms
Total Talk Time (CUSTOMER): 111348 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/412d2cc6-8593-46fd-bbde-874023022299_20250326T21:54_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 have a question about this plan. I kind of forgot that I had it. Um, how long do I have to uh claim and can I do it myself?
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Yeah, um, so I can go ahead and get your policy pulled up so I can provide more information, but in short, yes, uh, there's no timely filing limit, uh, and you can absolutely file claims yourself.
[CUSTOMER][NEUTRAL] But what if I already paid?
[AGENT][NEUTRAL] Let me get your policy pulled up. We'll see what kind that is, and I can kinda walk you through how you can do that. um, first though, I'm sorry, what was your name?
[CUSTOMER][NEUTRAL] [PII], last [PII]
[AGENT][NEUTRAL] OK, and then [PII], can I also get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. Do you have your policy number?
[CUSTOMER][NEUTRAL] I don't. I'm sorry, can I give you my social?
[AGENT][NEUTRAL] Oh, that's OK. Sure.
[CUSTOMER][NEUTRAL] And my social is [PII].
[CUSTOMER][NEUTRAL] 833-239
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] OK, and I just gonna verify some information really quick. Uh, can I get your date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Perfect. The last thing I need is the email address we've got on file for you. uh, looks like it might be through an organization.
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] Perfect. OK, thank you so much for verifying all of that information. OK, so yes, this is a secondary medical policy, uh, so it's designed to help with co-pay, deductible and co-insurance after your major medical pays. So this has been active since [PII] of this year, [PII]. So anything that you've had, um, any sort of medical treatment that you've received, you can absolutely follow those claims, uh, from that point until now.
[AGENT][NEUTRAL] What I would suggest going forward just so it's easier for you, uh, I know you said that you forgot you had the coverage, um, but whenever wherever you go for treatment, give them both, um, cards, so your major medical and this one so that they might be able to file the claim for you. You won't have to worry about it, um, let's see, but as far as filing like your claim, I'm sorry.
[CUSTOMER][NEUTRAL] So what
[CUSTOMER][NEUTRAL] What, what do I need if I've already paid this stuff?
[AGENT][NEUTRAL] Sure, yeah, um, OK, so all we would need for claims are going to be the itemized statement.
[AGENT][NEUTRAL] That shows diagnosis and procedure codes.
[AGENT][NEUTRAL] Let me know when you're ready. I don't know if you're writing it down, OK, um, so we got you, um, and then we would need the explanation of benefits from your primary insurance, basically just showing that they did help and you can get all of that information from the provider wherever you went for treatment they will have that information once you have that you can send it to us. You have a few different ways that you can file claims, um.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yeah, I'm ready. I'm
[AGENT][NEUTRAL] We've got a mailing address, a fax number, but uh do you have access to a desktop or a laptop computer?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Perfect. OK, um, so, uh, quickest and easiest way, uh, to get claim information to us is going to be through our online portal. Um, it does not have much support for mobile devices is why I ask, uh, so it would have to be done on a desktop or a laptop.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So you would just create an account um using all of that information that we just verified including that email then there's going to be a spot on the main page where you can upload documents you would just upload that information to us. We get it pretty quickly and then it would take about 7 to 10 business days for that to process.
[CUSTOMER][NEUTRAL] Well, do you, OK, I'm confused, so you pay, you're gonna pay the hospital and then they have to pay me back because I already paid it?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No ma'am. OK, so and it is a bit confusing. So how this works is if the provider was the one to file the claims we would send that payment to them however if you file that claim, we'll send that payment to you.
[CUSTOMER][NEGATIVE] Oh, so y'all can't get the EOBs and stuff on y'all end for us?
[AGENT][NEUTRAL] No, no, um, we, we have no way of getting those for you, um, now the providers can send that to us if they were wanting to file the claims they can, um, but if you had already paid it they probably won't so they can give you that information though.
[CUSTOMER][NEUTRAL] OK, well, can y'all call like our insurance people and do it and get it?
[AGENT][NEUTRAL] No, uh, we're unable to reach out like that for you, uh, but again, not just your insurance, the, uh, I think it'd probably be easier if you just called wherever you went. They, they'll have all of that for you the itemized statement and then that EOB.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK, OK, and what exactly what do they pay?
[AGENT][NEUTRAL] OK, let me get that pulled up and I was going to offer, um, if you would like I can send you a copy of this policy, [PII], um, it's very easy to read, not just so much jargon but it does go in depth as to what is and is not covered dollar amounts, frequencies, things like that. If you'd like me I can I can email this to you and then I can include a link uh to our online portal as well.
[CUSTOMER][NEUTRAL] Yeah,
[CUSTOMER][POSITIVE] Oh yeah, that'd be perfect.
[AGENT][NEUTRAL] OK awesome um did you want me to send it to this email that we've got or was there a different email you'd like me to send that to?
[CUSTOMER][NEUTRAL] Uh, that email is fine.
[AGENT][NEUTRAL] OK alright I will get that sent to you.
[AGENT][NEUTRAL] And if you needed any assistance, um, obviously this is it can be a bit overwhelming and confusing, um, but if you have need any help at all or clarification on anything, feel free to give us a call um we'll do what we can to clear any confusion up.
[CUSTOMER][NEUTRAL] So this will tell me, this email will tell me what.
[AGENT][NEUTRAL] Did you have any other questions for me at the moment?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] So this email will tell this email will tell me what they actually pay?
[AGENT][NEUTRAL] So that uh it will have your policy, um, I can kind of give you a brief little rundown, uh, if you'd like so.
[AGENT][NEUTRAL] They there's gonna be a separate two separate benefits um one is going to be for inpatient one is going to be for outpatient, so for your inpatient benefit, let's see.
[AGENT][NEUTRAL] That is going to be per calendar year that pays $2500 max and give me just a moment let me get and then your outpatient benefit, it pays on a per calendar day basis, so there's no yearly max. It's uh a daily max of $500.
[CUSTOMER][NEUTRAL] Oh, so like if I got like an MRI that I didn't have to stay in the hospital. I just, you know, and got it done.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure, yeah, most of it's going to be outpatient. Uh, the only thing that would be considered inpatient is if, you know, you had to stay at the hospital for longer than a day. That's generally how that would work.
[CUSTOMER][NEUTRAL] So it's not a percentage or anything because like say if my bill was, say if my bill was $1700 y'all gonna pay what for that MRI?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] OK, so yes, and again how this works is it's gonna be after your major medical pays so this plan is very dependent on your major medical. If they won't pay for a procedure or anything this policy can't. So say the procedure was a total of $1700 your major medical pays $1000 of that, and this policy could pay up to $500 additionally again that could go towards co-pays, deductible or co-insurance.
[CUSTOMER][NEUTRAL] OK, OK, I think I understand and uh does this count for me?
[AGENT][NEGATIVE] Yeah, it is a bit confusing.
[CUSTOMER][NEUTRAL] It doesn't count for dental, does it?
[AGENT][NEGATIVE] No, this plan does not have any dental benefits it's strictly medical.
[CUSTOMER][NEUTRAL] OK, OK, well I'll review that link and um I'll see um something, you know, getting some reimbursement.
[AGENT][NEUTRAL] Of course.
[AGENT][POSITIVE] Absolutely and if you again any questions you're not sure about anything give us a call right back um we'll be happy to help try to explain it.
[CUSTOMER][POSITIVE] Alright, I appreciate it so much thank you.
[AGENT][NEUTRAL] Yeah, of course. Was there anything else I could help you with at the moment?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] Alright, well thanks for giving us a call, [PII]. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] Alright you too bye bye.
[AGENT][POSITIVE] Thank you, bye bye.