AccountId: 011433970860
ContactId: 967e3cf9-35a3-49d1-a0c3-fa09244817c4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 529010 ms
Total Talk Time (AGENT): 250331 ms
Total Talk Time (CUSTOMER): 217356 ms
Interruptions: 2
Overall Sentiment: AGENT=1.1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/17/967e3cf9-35a3-49d1-a0c3-fa09244817c4_20250417T20:01_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][POSITIVE] Hello, [PII]. This is [PII]. They have us connected together, girl. They have us connected. Oh yes, they do.
[AGENT][POSITIVE] Yes, they do. I think they do.
[CUSTOMER][POSITIVE] And I have the sweetest lady on the phone. I'm so glad we're getting good calls.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Alright, Miss, Miss [PII], she was transferred to me from claims for [PII] and [PII] verified all the information, but she is verified. She was transferred to me to assist with the online service center. I helped her with that. She's now she just has questions about her gap and how it works basically and she may ask you how to upload a claim. We got, OK, and the policy is 257.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 3221.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Let me pull that up real quick.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Let's see
[AGENT][NEUTRAL] OK, it is Ms.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Uh AJ AJ.
[AGENT][NEUTRAL] Uh, how do you say
[AGENT][NEUTRAL] AJ, OK, that will, I can work that.
[CUSTOMER][NEUTRAL] AJ
[CUSTOMER][NEUTRAL] AJ
[CUSTOMER][NEUTRAL] That's what [PII] said she called her and I said, Miss AJ.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Ah
[CUSTOMER][NEUTRAL] OK, uh, you know, so I guess that's her first, you know, it is her first initial and middle name initial, so, um.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, so her phone number is the same that we have in the system, but I can give that to you real quick.
[AGENT][NEUTRAL] I've got it right here [PII].
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] That's it, darling. That is it.
[AGENT][NEUTRAL] And she needs benefit information and how to file a claim, is that correct?
[CUSTOMER][NEUTRAL] I, I know she definitely wants the benefit information, and we did go to the website and locate the med link claim form and she may ask you how to do, you know, get that what she needs to do with that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. All right, you can go ahead and put her through.
[CUSTOMER][NEUTRAL] OK, right.
[CUSTOMER][POSITIVE] Thank you, Tho. You have a great day, dear.
[AGENT][POSITIVE] You're welcome, [PII]. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Hi, Ms. [PII], this is [PII] in the care team.
[AGENT][NEUTRAL] So [PII] explained to me, hi, she explained to me that you need some benefit information, is that correct?
[CUSTOMER][NEUTRAL] Hi [PII].
[CUSTOMER][NEUTRAL] I do.
[AGENT][NEUTRAL] OK, I can help you with your benefits. Um, so what you have, um, is a secondary insurance that's billed um after your primary, and this is just to verify your benefits. It's not a guarantee of payment.
[AGENT][NEUTRAL] This policy helps with deductible, co-pay, and co-insurance.
[AGENT][NEUTRAL] You have an inpatient benefit amount per calendar year if you're in the hospital for 18 hours or more, that helps pay $5000 towards your deductible co-pay or co-insurance. And then you also have an outpatient benefit per calendar year of $1000.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so, um, I had a service where my um insurance did not pay less than $1000 for my deductible, um.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that was for a CT scan uh MRI.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] So this insurance would then come in secondary, is that right?
[AGENT][NEUTRAL] That's correct, um, but the primary explanation of benefits from the primary insurance needs to be sent in with the claim because it's based on what the primary pays, um, so that would need to be sent in along with the itemized statement from the facility that you went to showing.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][POSITIVE] Absolutely.
[CUSTOMER][NEUTRAL] From the provider.
[AGENT][NEUTRAL] Yes, showing the diagnosis codes and procedure codes and so your claim form, the EOB and the itemized statement.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I have all of that.
[AGENT][NEUTRAL] Oh good, OK, all that needs to be sent in.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and then the claims examiners will review the claim and it usually takes 7 to 10 business days after we receive the information for the claim to be processed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, not a worry on that time. I'm, I'm, I'm OK with that. Um, and then, so that was for the 5K was for the hospital, and then the 1,000K was for like the outpatient. So an MRI would be considered kind of an outpatient sort of thing, right?
[AGENT][NEUTRAL] What kind of facility? Did you go to a doctor's office? Did you go to an MRI imaging center?
[CUSTOMER][NEUTRAL] Imaging
[AGENT][NEUTRAL] Imaging center, OK, let me check on your policy and make sure that that's a covered facility.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's gonna be just a second while the computer pulls it up for me.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. Let me see.
[CUSTOMER][NEUTRAL] And the insurance did approve the pre-authorization, the primary insurance, if you need to know that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so your, your policy.
[AGENT][POSITIVE] Is good for use in an ER urgent care center, MRI imaging center, or an ambulatory center.
[CUSTOMER][NEUTRAL] Perfect. OK, so I will submit the claim for that that would exhaust me on the out kind of an outpatient, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And t[PII]
[CUSTOMER][POSITIVE] That's it, right? I, that's all I have to do is just submit and then I'm good.
[AGENT][NEUTRAL] Right, you submit it and like I said, it will be.
[CUSTOMER][POSITIVE] Well, of course you've got to approve it, review it and all that, yeah.
[AGENT][NEUTRAL] Right, right, and the, and the EOB to show what the primary paid or didn't pay, all of that will need to be under review.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yep, I will submit that and then um.
[CUSTOMER][NEUTRAL] Uh, yeah, outside of that, um.
[CUSTOMER][NEUTRAL] That's really, that's pretty much it. It covers those big, large things like a hospital stay or
[CUSTOMER][NEUTRAL] Um, an MRI really, right?
[AGENT][NEUTRAL] Right. Um, it just covers, uh, and it, it does do big things, but like if uh you go into an outpatient facility and you have a copay or you have a co-insurance or a deductible, then it'll pay um up to one.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] $1000 a year. So if you only use $50 let's just say as an example, you only use $50 then you would have the rest of it to use throughout the year, but once that $1000 benefit is exhausted, then it will stop paying until the next calendar year.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEGATIVE] Gotcha. Um.
[CUSTOMER][NEUTRAL] Yeah, and that's really the big one. I mean, I've had other co-pays and deductibles that I've had with coinsurance that I've had to pay for, but I mean those are small compared to this $1000.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, right, I understand.
[CUSTOMER][NEUTRAL] So yeah, so I have downloaded the claim form. I have the bill and I can access the EOB online um I don't have any other questions.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] OK. All right. Well, Ms [PII], um, I'm glad I was able to help you with all of your questions and I'm hoping that you have a wonderful Easter, and we thank you very much for calling APL.
[CUSTOMER][POSITIVE] Perfect, and I thank you too, and you have a good Easter as well.
[AGENT][POSITIVE] Thank you, ma'am. Thank you.
[AGENT][POSITIVE] Alright, well you take care.
[CUSTOMER][NEUTRAL] Bye-bye.
[AGENT][NEUTRAL] Bye-bye, ma'am.