AccountId: 011433970860
ContactId: 5bb43625-2401-4368-a52d-b941bbe04861
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 425179 ms
Total Talk Time (AGENT): 223911 ms
Total Talk Time (CUSTOMER): 178141 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=-0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/21/5bb43625-2401-4368-a52d-b941bbe04861_20250221T15:33_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII], and I had a couple of questions about what exactly it is that you guys cover or do. I just know I'm paying for that work.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, absolutely. So, I'm sorry, do you have a policy with us or are you a provider?
[CUSTOMER][NEUTRAL] Yeah, I have a policy with you guys. um, I have my individual policy number, I guess that's what it is.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yeah absolutely if you wanna give that to me I'm happy to pull that up.
[CUSTOMER][NEUTRAL] So it has a pair ID and then it has a policy slash certification number. Is that the number you need?
[AGENT][NEUTRAL] Yeah, the policy slash cert number, that's the one I need.
[CUSTOMER][NEUTRAL] 0225 I'm sorry 02 51 9450.
[AGENT][NEUTRAL] Alright, thank you [PII]. Let me pull this up here one moment.
[CUSTOMER][NEUTRAL] I think I kind of have an idea. I just wanna make sure.
[AGENT][POSITIVE] Yeah, no problem.
[AGENT][NEUTRAL] Um, and then for security, I do need to verify please your date of birth and address.
[CUSTOMER][NEUTRAL] [PII] um address is [PII].
[AGENT][NEUTRAL] Thank you and then the email on file is the [PII] account is still a good email for you?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Great. Alright, so it looks like this policy that you have with us is what we call a secondary policy or a gap policy. It's really meant to bridge the gap between your major medical and um this. Hopefully you won't have any sort of like out of pocket cost. So this plan picks up anything for the most part that your major medical does not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so now my question to you is, um, I have an MRI scheduled.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] I reached out to my plan, and they told me that I'm gonna have a co-insurance or co-cost or whatever. Is that what I use this for?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Right, right.
[AGENT][NEUTRAL] Yes, so let me make sure, you said you're having, you're having an MRI?
[CUSTOMER][NEUTRAL] To do
[CUSTOMER][NEUTRAL] Yeah, um, I emailed.
[CUSTOMER][POSITIVE] I guess it's Cigna, who was my coverage. So I emailed them, gave them the girl that I scheduled the MRI with was really nice. She gave me all the codes, everything. So I provided them insurance, make sure that the place that I'm having is in-network. And I think roughly she told me like my co-pay or whatever my responsibility is, is gonna be like $500 to $600.
[AGENT][NEUTRAL] Mhm. Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let me pull up your policy and see here.
[CUSTOMER][NEUTRAL] Hello
[CUSTOMER][NEUTRAL] So that's why I have it scheduled. I need to confirm, but honestly, that's a lot of money.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK. So, MRI's are covered. Um, diagnostic testing performed in a hospital outpatient facility or an MRI facility or physician's office. So that is covered under your outpatient benefits. So let me see what your benefit max would be.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, so it looks like.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] Your outpatient benefit max for the calendar year is $2,025. And if you haven't used anything, then you have that full amount for the year. So honestly, [PII], the easiest way to do it if they're willing to do it is wherever you're having the MRI at.
[CUSTOMER][POSITIVE] I like that.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Give them your primary insurance and then let them know that we're your secondary and that we pick up.
[CUSTOMER][NEUTRAL] What I did
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Deductible, co-pay, and co-insurance.
[AGENT][NEUTRAL] And that they can then bill us for anything that your primary doesn't carry and if they need to call us to verify benefits they can do that too.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, then I'm gonna call them, because the girl, I told her, I know I'm paying for a gap. She said, you have a card, and I told her, honestly, I don't remember. And then I found it at my desk. My boss gave it to us one day.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] Oh, I was, I was gonna say I can email you one if you need one. I can get you one.
[CUSTOMER][NEUTRAL] He gave it to us and I was cleaning my desk yesterday and I'm like, oh this must be the insurance card, cause he's like, some of you guys got it, I don't know what it is, but here it is. And I was like, OK. And I was like
[CUSTOMER][NEUTRAL] So that's what it is, and I'm, you know what, I'm gonna call cause I have that MRI coming up. And it isn't an outpatient service.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, yeah so yeah they should be able to bill us for that it's definitely covered under your plan it's in the policy, um, yeah, and just give them that card information and they can call and verify whatever they need to. So yeah, you shouldn't have to pay anything right now they should be able to bill your primary then bill us and then.
[AGENT][NEUTRAL] You shouldn't have to pay anything it looks like, so.
[CUSTOMER][NEUTRAL] Yeah, because I had to go take some allergy tests. I had to go take some allergy tests and everything, and I just paid for that.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah, I mean, if you've
[CUSTOMER][NEGATIVE] Because they told me, oh, this one's not covered.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] I don't know. I mean, allergy testing.
[AGENT][NEUTRAL] I'm not sure, let's see.
[CUSTOMER][NEGATIVE] And I had to take a breathing test and that wasn't covered either. So I paid for all of that cash.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Which I don't think it would be covered.
[AGENT][NEUTRAL] Yeah, it might not be.
[CUSTOMER][MIXED] Which is fine. I mean, it wasn't like an arm and a leg, it was more doable. It was like $50.60 dollars, but it's more doable than $500.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Right out the bat.
[AGENT][POSITIVE] No, yeah, for sure, for sure. So yeah, I mean, definitely, um, this should definitely cover that like it's listed in the policy, so um and if they won't, um, you know, submit the claim, then you can obviously do it, but it's much easier if they'll just submit it for you. Yeah.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] If they do it.
[CUSTOMER][NEUTRAL] I think they will. I mean, they're a pretty big facility. I feel like they, they deal with that quite frequently.
[AGENT][POSITIVE] Yeah, yeah, yeah, for sure. Did you have any other questions or concerns [PII] I can help with today?
[CUSTOMER][NEUTRAL] No, actually that was my only question because my MRI is coming up and I was like, you know what, let me see if it's gonna be covered or not.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] All right, not a problem. Well, we're happy to help.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much. Have a great day.
[AGENT][POSITIVE] You, you're welcome. You too. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.