AccountId: 011433970860
ContactId: 5a59814c-0ab3-4e12-82b4-a8a07e16a25a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 622419 ms
Total Talk Time (AGENT): 411972 ms
Total Talk Time (CUSTOMER): 183515 ms
Interruptions: 3
Overall Sentiment: AGENT=1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/07/5a59814c-0ab3-4e12-82b4-a8a07e16a25a_20250307T14:36_UTC.wav
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[AGENT][POSITIVE] Thank you for calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, yes, I was on hold and got disconnected. Um, my name is [PII], and I needed to verify my medical insurance information.
[AGENT][POSITIVE] OK, I can help you with that.
[AGENT][NEUTRAL] Can I get a callback number for you?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] OK, thank you. And what is your policy number with us, [PII]?
[CUSTOMER][NEUTRAL] Um, it's 02596030.
[AGENT][NEUTRAL] If you could verify your date of birth and mailing address please.
[CUSTOMER][NEUTRAL] OK, my date of birth is [PII]. My mailing address is [PII].
[AGENT][POSITIVE] OK, thank you so much for verifying your account and you're calling uh with benefit questions today?
[CUSTOMER][NEUTRAL] Um, yes. So, um, I was just at the doctor and, um, I, I, I'm hoping that this was the right card that I gave them, and they did not the claim. They said they didn't accept the insurance. So with mammogram, do you guys cover that?
[AGENT][NEUTRAL] Your routine mammogram?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Let me see, so normally.
[AGENT][NEUTRAL] Let me take a look. OK. And I misheard you. You said you had the uh doctor's appointment and they said they do not accept the insurance?
[CUSTOMER][NEUTRAL] Yes, so I was just wondering, I mean, so the name of the insurance company is ATL. Is that correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEGATIVE] OK, so I gave them, I guess the card information that you guys sent to me, and the problem is they said they didn't accept this insurance, so they denied the claims for my mammogram.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Now,
[AGENT][NEUTRAL] The type of policy that you have is not a contracted policy. So, um, like you don't have a list of providers, you are able to go to any doctor. Um, but the doctor does have, um,
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] The choice to accept or not accept the insurance. Um, so it's not that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You know, it just could be them and them saying, hey, we, we, we just don't accept this insurance, um, but there's no contract, so it's not like, oh, we're not in their network, so we can't take the insurance. I guess they're just deciding not to, um.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] But uh let me check here.
[AGENT][NEUTRAL] I mean, so you do have benefits for diagnostic testing. Um, now, the type of policy you have, um, there are different, bless you, um, different administrators, uh, so for like, you could have additional benefits for like your routine services.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] And they would have to, you know, contact, uh, IMA uh for that information, any provider if there's additional, but you do have a benefit that will cover, um, let me pull up the actual policy, just to make sure.
[CUSTOMER][NEUTRAL] And I think it's like 1, it's like 1 procedure per per pound a year, is that correct?
[AGENT][NEUTRAL] Let me take a look. Uh, it looks like it's a dollar amount and not a
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It'll just pay up to, uh, a certain amount per year, but let me pull the benefits and and just make sure I'm giving you the correct information. Hold one moment.
[CUSTOMER][NEUTRAL] It's like,
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] I think the lady was trying to call me back.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so please be advised verifying benefits does not guarantee payment. So you do have benefits for diagnostic testing.
[AGENT][NEUTRAL] Um, it will pay up to $100 a year.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] But if there are additional benefits, like I said, sometimes, uh, you, these type of policies, you may have additional uh routine uh benefits, um, and you would just have to contact, uh, IMA uh to get that information to, and they'll let you know if you have any additional benefits.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For a routine, but through this policy.
[CUSTOMER][NEUTRAL] OK, you said I am Ma?
[AGENT][NEUTRAL] Yes, let me get their number so.
[CUSTOMER][NEUTRAL] OK. So, I mean, I've already paid for the procedure today cause I was just informed of that information that they um didn't cover that. But this is the correct card. Is it the card that came with the packet?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It is
[AGENT][NEUTRAL] Yes, so it is the correct card. Uh, what you can do, since you did pay out of pocket, you can submit a claim, um, for reimbursement, and you would want to send that claim first, like I said, to IMA to just make sure you don't have additional benefits, um, and then they will submit the claim to us.
[AGENT][POSITIVE] But I can give you their number or transfer you over that way you'll know if you do have those additional benefits for routine.
[CUSTOMER][NEUTRAL] Oh
[AGENT][POSITIVE] Um, and if, you know, so I can get you over to them, uh, to find that out, but you can submit a claim yourself and we, uh, if benefits are due, we will reimburse you for that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and you said it was just $100?
[AGENT][NEUTRAL] Uh, yes. So it's uh $100 a year. Uh, and then I think you would also get uh the physician benefit for the visit.
[CUSTOMER][NEUTRAL] Per year.
[AGENT][NEUTRAL] Um, let me see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like that is a $50 benefit.
[AGENT][NEUTRAL] Uh, you can use 4 of those a year. So, you know, you have different benefits and I would suggest to just send that information in, um, you know, the itemized bill with your charges and your diagnosis on there and, uh, just see what, what you're due, and we will reimburse you the benefits that you have for the service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what is their number, please?
[AGENT][NEUTRAL] Uh, IMA is 1800.
[AGENT][NEUTRAL] 8334296.
[CUSTOMER][NEGATIVE] OK. And you said you can transfer me. So this is, I just wanna make because they gave me so many, they gave me so many packets, and I'm just trying to clarify what I'm entitled to because this is my first time having insurance with you guys, you know, I'm so used to like the, the major insurance companies and this is my first time um.
[AGENT][POSITIVE] Yes, ma'am, I can.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] You know, ever having to
[CUSTOMER][NEGATIVE] Use this policy, um, and I'm just concerned.
[AGENT][NEUTRAL] You, yes, so you, it, it is the card you have for us, always submit that card and most providers know, you know, they, um,
[AGENT][NEUTRAL] Even when they call us for the benefits, we do let them know that claims go to IMA uh because like I said, if there are any additional benefits, you want them to pay on those also and then if they know that they have other coverage through us, that is a possible payment then they submit the same claim to us. So that way you're getting, you know.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] All the benefits that are due to you.
[CUSTOMER][NEUTRAL] Right, but, right, but if they just, but they have the option because I used to work at the hospital, so they have the option to say they don't accept the insurance at all, um, and I get that, but um.
[AGENT][NEUTRAL] Correct, all providers have that option.
[CUSTOMER][NEUTRAL] Yeah, and so you don't have a list of providers. You just have to make sure that whoever we go to accept that policy, is that correct?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Right. So you, you know, like just say if you go to a new provider, you just let them know it's a limited medical plan. Like you said, it's not a major medical plan. There is no contract, you know, so once they hear that, they know, OK, it just, it's a limited medical plan, it's gonna pay up to a certain amount, um, and we don't have to be in a network with them. So, uh, and then it is the choice of the provider to say, OK, yeah, we'll go ahead and take that. But some
[CUSTOMER][POSITIVE] OK, I got you.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You know, may say, you know, you'll have to pay up front and then, uh, submit a claim for reimbursement.
[CUSTOMER][NEUTRAL] And is that the same? do I use this card with my prescription?
[AGENT][NEUTRAL] No, it looks like your prescriptions are through Pharmavale, um,
[AGENT][NEUTRAL] And I'm not sure if you receive a card for that or they just, you just have the [PII] number and they contact them uh to verify your, your benefits. But again, that's through a different administrator. That's the thing, this policy does have.
[CUSTOMER][NEUTRAL] I've been getting
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Different administrators so you kinda go through different channels for different benefits.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And see that's the thing because I didn't get a card for my prescription and I do take um.
[AGENT][NEUTRAL] Yeah, I'm not sure if they provide a car. They may, but you would have to contact them and if they do, um,
[AGENT][NEUTRAL] Provide a card, um, they'll submit that to you. So the card you're looking at, does it, I thought they used to, uh, some of the insurers would say there's like a list of numbers on there. Do you see anything that says Farmerville?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, yeah, OK, yeah, that's the number. OK.
[AGENT][NEUTRAL] OK, so yeah, I think the card like if they look at the card, they'll see the different numbers to call for whatever benefit it's for. So I, I'm assuming you would submit the card you have and then they would see or let them know form bill is who they contact for your prescription benefits.
[CUSTOMER][NEUTRAL] Alright, I got you. OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Just see
[CUSTOMER][POSITIVE] Excuse me. OK, thank you so much for your help.
[AGENT][POSITIVE] You're welcome, [PII]. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] Uh, that is it. Thank you.
[AGENT][POSITIVE] OK, you have a wonderful weekend. Thank you for calling American Public Life. Bye-bye.
[CUSTOMER][POSITIVE] You too, thank you.
[CUSTOMER][NEUTRAL] OK. Bye-bye.