AccountId: 011433970860
ContactId: 7d1aa84f-7746-4ce0-a73f-54951acbc774
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 520960 ms
Total Talk Time (AGENT): 233279 ms
Total Talk Time (CUSTOMER): 157789 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/7d1aa84f-7746-4ce0-a73f-54951acbc774_20250212T15:10_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, [PII], how are you doing?
[AGENT][POSITIVE] I'm good, how are you?
[CUSTOMER][NEUTRAL] All right, um, my name, let me provide you my social so you could have an idea of my benefits.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], what's a good phone number, [PII] in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] I was pulling up looking locating your policy number. I have it now. Can you verify your, your date of birth and your mailing address?
[CUSTOMER][NEUTRAL] I'm sorry, yeah.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And your email address on file.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thanks [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] OK, quick question. Um, I have a, uh, a procedure being done today, a colonoscopy procedure, and the total amount is $1800 right?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And I provide them the you guys information and they went ahead and called already and they spoke to one of you guys.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And they say that um that you guys are only covering $1000. Can you verify that for me, please?
[AGENT][NEUTRAL] Let's see, your maximum outpatient benefit is up to $1000 per calendar year. Is the colonoscopy a screening or are they doing it for a medical concern?
[CUSTOMER][NEUTRAL] It's a medical concern.
[AGENT][NEUTRAL] OK, yeah, your maximum outpatient benefit is up to $1000 per calendar year, so whatever amount your major medical insurance applies towards your deductible.
[AGENT][NEUTRAL] Um, this policy will cover up to $1000 of that amount.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Ah, so what if I were to just file a claim on?
[AGENT][NEUTRAL] What do you mean?
[CUSTOMER][NEUTRAL] You know, this, um, you know.
[CUSTOMER][NEUTRAL] File a claim and then go ahead and pay them for myself.
[AGENT][NEUTRAL] So you can instead of your provider sending it to us, you mean you're gonna send it yourself?
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] Is that, is that what you're saying?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I mean you can file the claim yourself.
[AGENT][NEUTRAL] Mhm, are they requiring that you pay something up front or no?
[CUSTOMER][NEUTRAL] Yes, they are.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, so if they're requiring you to pay something up front now remember you'll have a facility charge and then you'll have a charge from the.
[AGENT][NEUTRAL] I guess it would be a surgeon who's gonna perform the, the, the, the colonoscopy. So you, you know, and then an anesthesiologist bill. So who, who's is it the hospital that's requesting you, requiring you to pay upfront?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes, like I already paid already, like.
[CUSTOMER][NEUTRAL] Over $1000 so.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] What, um, I still have to like fax you guys those paperwork.
[AGENT][NEUTRAL] Yeah, you can submit your uh uh APL claim form, maling claim form, and then an itemized bill that you would need to get from the hospital, but keep in mind, let's say the surgeon sends in their bill before you send yours in.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Then that benefit is gonna go to whoever's claim we receive first, so keep that in mind.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah, yeah, yeah, I understand.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So
[CUSTOMER][NEUTRAL] So, uh,
[CUSTOMER][NEUTRAL] So what, so I need to get the bill form.
[AGENT][NEUTRAL] You know, so, um, get an itemized bill.
[CUSTOMER][NEUTRAL] random, right?
[AGENT][NEUTRAL] The auto mhm and make sure the diagnosis code and procedure code is on your bill.
[CUSTOMER][NEUTRAL] Out of my bill
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It should be, but make sure that you let them know that that needs to be included in that document.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And then since we're secondary to your primary insurance, uh, we'll also need a copy of their explanation of benefits for this date of service as well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then if you're gonna send it yourself well you'll need to complete the ATL met link claim form.
[AGENT][NEUTRAL] That can be downloaded from our website, yeah, I can email it to you if you want me to.
[CUSTOMER][NEUTRAL] OK, can you send me that?
[CUSTOMER][NEUTRAL] OK, yeah, please, please, please.
[AGENT][NEUTRAL] Hold on, hold on one second. Did you say it's today?
[CUSTOMER][NEUTRAL] Yes, it's today.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me get this over to you. I just wanna make sure that you receive it and are able to open it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What's the weather like there in [PII]?
[CUSTOMER][POSITIVE] Funny right now.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, and you guys are like, well, not you guys, I mean like where are you at?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] I'm in [PII].
[CUSTOMER][POSITIVE] Oh, [PII], nice.
[AGENT][NEUTRAL] Oh, [PII].
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And we, we have sleeting snow today.
[CUSTOMER][NEUTRAL] What? Fleeting snow.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, it's more like icy.
[CUSTOMER][POSITIVE] Wow.
[AGENT][NEUTRAL] It's not really, yeah. Yeah, like, yeah, like a thin slate of ice on the roads.
[CUSTOMER][NEGATIVE] 01 of those, one of those bad, yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Be careful with that.
[AGENT][POSITIVE] OK, let me get this prepared for you.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And can you put like a little small notes?
[CUSTOMER][NEUTRAL] Can you, can you do that, please?
[AGENT][NEUTRAL] Can I do what?
[CUSTOMER][NEUTRAL] On the email, put like little small notes of um I need like the item my bills with all the holds.
[AGENT][NEUTRAL] It's on the first page of the claim, uh, the first page of the claim form or or instructions actually, and it'll tell you what documents that you need to send to us.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][POSITIVE] OK, OK, OK. Thank you.
[AGENT][NEUTRAL] So I'm sending it to [PII]
[AGENT][NEUTRAL] [PII], right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Let me see if I got it.
[AGENT][NEUTRAL] Give it a few minutes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] And of course the benefit information provided is just a verification, not a guarantee of payment because we have to receive the claim for review.
[CUSTOMER][NEUTRAL] Of course.
[AGENT][NEUTRAL] It's coming from Tanya Rivers.
[CUSTOMER][NEUTRAL] Got it. It just came. Tanya Rivers.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, let me open it now.
[AGENT][NEUTRAL] OK. And then you'll see the instructions on page one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, I see, complete the statement on. Alright, so complete that form, right?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] It'll tell you which sections to complete and then below that it'll tell you what documents are needed, which will be the itemized bill and the major medical explanation of benefits and then our claim form which is which is what you just received.
[CUSTOMER][NEUTRAL] Which is
[AGENT][NEUTRAL] Any other questions, Mr. [PII]?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] Alrighty well thank you for calling APL and hopefully everything goes well.
[CUSTOMER][POSITIVE] Thank you very much. Bye.
[AGENT][POSITIVE] Alrighty you're welcome thanks for calling ATL have a good day.
[CUSTOMER][NEUTRAL] Of course, you too. Bye.