AccountId: 011433970860
ContactId: 57fcb9b0-728a-45c1-a78f-19365540636b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 321880 ms
Total Talk Time (AGENT): 112600 ms
Total Talk Time (CUSTOMER): 167960 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/57fcb9b0-728a-45c1-a78f-19365540636b_20250415T13:56_UTC.wav
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[AGENT][NEUTRAL] For calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good morning. This is [PII] in customer service. I have um Ms. [PII] on the line with policy number 251.
[CUSTOMER][NEUTRAL] 82887.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, she is inquiring about, um, MRI benefit. Um, how much would APL would cover reimburse her for it?
[AGENT][NEUTRAL] OK, you can send her over.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Mhm, no problem.
[AGENT][POSITIVE] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, uh, my name is [PII]. I have a question. I have a prescription to get an MRI done, and I have a copay attached to it with my insurance plan, so I wanted to see for reimbursement cause I believe you guys reimbursed. I just need to know how much is reimbursable with this plan and then what is required for me to submit.
[AGENT][NEUTRAL] OK. Yes, ma'am. I can assist you with your benefits. Um, first, could you please verify your policy number again, please?
[CUSTOMER][NEUTRAL] Yeah, no problem. Let me see where I, where did I put it I send it out. Give me a sec here.
[CUSTOMER][NEUTRAL] OK, policy number is 025182887.
[AGENT][NEUTRAL] Thank you. Now, please verify your name and date of birth.
[CUSTOMER][NEUTRAL] My name is [PII]. Uh, date of birth [PII].
[AGENT][NEUTRAL] OK, thank you, [PII] and please verify, um, let's see, your mailing address and your email address just to make sure that we have the right information on file.
[CUSTOMER][NEUTRAL] Yeah, no problem. [PII].
[AGENT][NEUTRAL] OK. And the email address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I'm showing a different email address.
[CUSTOMER][NEUTRAL] Uh, might, uh, might be my work email, er [PII].
[AGENT][NEUTRAL] Yes, that's the one we have on file.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And you're verifying benefits for MRI?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, yeah, so I have a copay of like $500 but I think if I submit it to APL, they reimburse me a certain amount. I just wanted to know how much that is and then what is it that you actually need, because I know in the past I've submitted stuff like I submitted my EOB but my EOB doesn't have like a diagnosis code or indication, so I just needed to know what exactly is it that you guys are looking for.
[AGENT][NEUTRAL] Um, yes, sir. Let's see, to submit a claim.
[AGENT][NEUTRAL] Let's see, we would need the explanation of benefits and we'll also need the diagnosis code, so that has not changed. And um the diagnosis code.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so it
[AGENT][NEUTRAL] Mhm. And you use.
[CUSTOMER][NEUTRAL] Would it be the ICD code?
[AGENT][POSITIVE] ICD, yeah, ICD 10 code. Yes, that's correct.
[CUSTOMER][NEUTRAL] Yes, OK, so I have that on the prescription so I can make a copy of the prescription and send that in with the EOB.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, good, good to know. So then I now the only thing is how much is reimbursable.
[AGENT][NEUTRAL] OK. And
[AGENT][NEUTRAL] Right, for outpatient services, um, we reimburse up to 2025 per calendar year and that's for the co-pay, the co-insurance, and the deductible after the primary insurance processes the claim.
[CUSTOMER][NEUTRAL] OK, so I would be reimbursed $500 is what you're saying if I had no other claims for the year and, and my co-pay with the insurance would be $500 so I should get $500 back.
[AGENT][NEUTRAL] Right. If your co-pay is $500 we'll reimburse $500 back cause I'm showing that we cover up to $2,025 per calendar year. Have you used any of your, let's see if you've used any of your benefits. OK, yeah, so the full 2025 is available. We would just need to show that on the explanation of benefits cause of course, if your primary insurance does not cover anything, if they deny it, then we deny it also.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But the portion that goes towards copay, co-insurance or deductible is covered.
[CUSTOMER][NEUTRAL] Right, got you that.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Gotcha. Yeah, I experienced that with my wife with the insurance didn't cover it, and, and we couldn't submit it to APL, so I, I, I got that. So I just want to make sure that there's no other new policy with submitting stuff, so you need a copy of the pres as long as there's an ICD 10 code and the explanation of benefits showing that the insurance covered it.
[AGENT][POSITIVE] That's correct.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][POSITIVE] OK, cool. All right, thank you so much. I appreciate it.
[AGENT][NEUTRAL] OK. Is there anything else I can assist you with?
[CUSTOMER][POSITIVE] No, that's it. Thank you. Have a good morning.
[AGENT][NEUTRAL] Yeah, and [PII], you do the same. Thank you for calling APL. Mm bye.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] All right bye bye.