AccountId: 011433970860
ContactId: a6ca65a5-1c8f-49cd-a4a5-39b27795c85b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 857799 ms
Total Talk Time (AGENT): 397987 ms
Total Talk Time (CUSTOMER): 286151 ms
Interruptions: 2
Overall Sentiment: AGENT=1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/a6ca65a5-1c8f-49cd-a4a5-39b27795c85b_20250108T18:35_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, yes, I'm trying to get some information on submitting um some deductibles for my claim, a claim.
[AGENT][NEUTRAL] Oh OK, yeah, meeting.
[CUSTOMER][NEUTRAL] For my deductibles?
[AGENT][NEUTRAL] OK, just needing help filing a claim?
[CUSTOMER][POSITIVE] Yes, I'm, I've never done it for years and I'm just like right now trying to do it. If you can help me.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Sure, no worries.
[AGENT][POSITIVE] Of course I'll help you out. uh, what was your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, thank you. Do you have your policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The policy number, is that a group number or?
[AGENT][NEUTRAL] Are you looking at a cord?
[CUSTOMER][NEGATIVE] I don't work.
[CUSTOMER][NEUTRAL] I have a policy number actually. I just came across it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 01659141
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] All right. And what was your last name, [PII]? I'm sorry.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Alright, thank you. I'm just gonna verify some information really quick uh can I get your date of birth please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and then can I get your mailing address?
[CUSTOMER][NEUTRAL] Mailing address is
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And that's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I've got a different address for you, [PII]. I've got one in [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, [PII]. Sorry, my mind just went blank.
[AGENT][POSITIVE] No, that's all right. I appreciate you verifying that. Does that need to be updated?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, could you give me the correct address again?
[CUSTOMER][NEUTRAL] Let me give you this 1. [PII].
[CUSTOMER][NEUTRAL] 70
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, that was [PII] or [PII]?
[CUSTOMER][NEUTRAL] [PII] without the A, without the S.
[AGENT][NEUTRAL] Got it. OK, yes, OK, perfect, thank you. Alright, I will get that updated uh last thing I need is the email address that we've got on file for you. uh, looks like it is an [PII] account.
[CUSTOMER][NEUTRAL] OK. [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Alright, yes, thank you so much for verifying that information, OK.
[AGENT][NEUTRAL] So [PII], you've got a couple of different ways to file claims with us, bear with me just a moment.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What I would recommend, uh, the quickest and easiest way I would say to get claim information to us is through our online portal. Do you have access to a desktop or a laptop computer?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK um I can give you that web address, um, essentially there's going to be a spot after you create a log in um where you can upload documents it gets to us very quick and of course we'll be able to process it that much quicker um let me know when you're ready for that information I can give that to you.
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] OK, so the web address is it's the word secured with an ED.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and so all of the information uh that we just verified, that's what you would use uh to.
[AGENT][NEUTRAL] Oh goodness, that's what you would use to create a log in?
[AGENT][NEUTRAL] And then once you do that of course you'll be able to upload that information um and then if you've got a pen if you're using a pen I'll let you know the required information we need to file claims let me know when you're ready.
[CUSTOMER][NEUTRAL] OK, go ahead.
[AGENT][NEUTRAL] OK, so we need an itemized statement.
[AGENT][NEUTRAL] That shows diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] Itemized statement with diagnosis.
[AGENT][NEUTRAL] Diagnosis and procedure codes, yes, ma'am.
[CUSTOMER][NEUTRAL] And procedure.
[AGENT][NEUTRAL] And then we also need, excuse me, the explanation of benefits from your primary insurance essentially showing us.
[AGENT][NEUTRAL] You know, the their information there and you can get all of that information from the provider you went to for treatment they will have all of this information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And once you've got that you can simply upload that to us from from the website. It can take about 7 to 10 business days for claim information to process. You can do the status of the website or of course you're more than welcome to give us a call as well.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you have any questions for me? I know it could be a bit confusing.
[CUSTOMER][NEUTRAL] It's a little confusing, but, um, so I would have to get the itemized statement with the diagnosis and procedure codes from the doctor during the
[CUSTOMER][NEUTRAL] The um procedure, I guess. And then also,
[AGENT][NEUTRAL] Yeah, wherever he went for treatment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so for the specialist and then the um explanation of benefits, I will get that through the insurance.
[AGENT][NEUTRAL] No, the, the provider, they'll have that information too so that the explanation of benefits they will have that as well so you can ask them for that all at once.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Provider.
[CUSTOMER][NEUTRAL] And then, um,
[CUSTOMER][NEUTRAL] Is this only for specialists?
[AGENT][NEUTRAL] Uh, let me take a look at your policy here.
[CUSTOMER][NEUTRAL] Um, I'm not sure about the benefits, that's why I'm asking these questions.
[AGENT][POSITIVE] Oh sure, no worries, give me just a moment.
[CUSTOMER][POSITIVE] It's OK for the offices.
[CUSTOMER][NEUTRAL] The copay for the office to say.
[AGENT][NEUTRAL] Let me get your, uh, I'll get your policy pulled up here just a minute.
[AGENT][POSITIVE] And I can send this policy to you as well if you'd like [PII], so you've got it for your records. Uh, it's very easy to read, not just a bunch of jargon, I promise, um, but it does go in depth as to what is and is not covered dollar amounts, frequencies, things like that.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Yes, if you would do that, that'd be great.
[AGENT][NEUTRAL] Did you want me to I can email it to you. Did you want me to email it?
[CUSTOMER][NEUTRAL] Yes, that's fine.
[AGENT][NEUTRAL] OK, uh, to this AOL account we've got it?
[CUSTOMER][NEUTRAL] Yes, that's
[AGENT][POSITIVE] OK alrighty I will get that sent to you as well give me just a moment.
[AGENT][POSITIVE] I always like having something I can go back and reference that's just me.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, bear with me just a moment, I'm gonna go ahead and send it to you now.
[AGENT][POSITIVE] Alrighty. I did just send that. Give me just a moment, let's take a look here at your benefits.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Excuse me, OK.
[AGENT][NEUTRAL] OK, so for this policy.
[AGENT][NEUTRAL] Office visits are covered.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] I think it might just be a different amount that's usually how it is, um.
[AGENT][NEUTRAL] For specialist versus uh an actual physician's office.
[AGENT][NEUTRAL] Just a moment to find that.
[CUSTOMER][NEUTRAL] So both you're saying that my PCP as well as the specialist are covered. They're just different amounts.
[AGENT][NEUTRAL] Should be give me just a moment let me get that accurate information for you.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Excuse me, all right.
[AGENT][NEUTRAL] Here we are, OK, yes.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] Uh it might be a little bit um.
[AGENT][NEUTRAL] Complicated sounding but essentially you've got a benefit for the visit itself and then you've also got benefits for uh treatment received in office so they would be two separate benefits. So the office visit itself for a specialist office visit it this uh policy pays up to $50 per visit, maximum of 4 visits per calendar year.
[AGENT][NEUTRAL] For a physician's office, that would be up to $25 per visit, maximum of 4 visits per year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So for the specialist, it's
[AGENT][NEUTRAL] And again, that's just for the visit. 50, up to 50.
[CUSTOMER][NEUTRAL] OK. Up to $50 per specialist, up to 4 visits a year, and then $25 for the, the uh primary, up to 4 visits a year also.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Correct, yes ma'am, and again that's just for the visit itself, um, that's not going to be counting like if treatment receives in office, that would be separate benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And is there a limit for those um treatments or?
[AGENT][NEUTRAL] Not necessarily, um, it really does depend on what it is. I would say the biggest, uh, limit would be just the dollar amount itself for your outpatient benefit so per calendar year, your total outpatient benefit is $2500 max.
[AGENT][NEUTRAL] So until it reaches that amount then we wouldn't be able to pay anything additionally for outpatient benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So, let me ask you this. If I had to go, um, I went to my PCP and she referred me to go to the hospital to get some work, uh, get checked out. Would that be covered?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You do have hospital, let's see.
[AGENT][NEUTRAL] Was it an emergency room?
[CUSTOMER][NEUTRAL] It was an emergency room.
[AGENT][NEUTRAL] It was OK. Yes, you do have hospital emergency room is a covered outpatient facility, so yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Cause I know I had to get some tests done, uh, like a heart check and monitored and all of that. So I was wondering if that was checked. And now, this was last year. Is there like a deadline for me to submit these claims or?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Oh no, no, ma'am, um, there's no timely filing limit as long as your policy was active during that time, you can file those claims whenever you're able to.
[CUSTOMER][NEUTRAL] OK. Cause I mean, I have never filed a claim and I've had this insurance for years, but
[AGENT][POSITIVE] Oh goodness.
[AGENT][NEUTRAL] Yes, you have.
[CUSTOMER][POSITIVE] I, I just didn't know how to use it, so I've just never done it. But definitely, um, I will start using it because it is a good benefit to have. I know.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] Absolutely, yes ma'am.
[CUSTOMER][NEUTRAL] So, OK.
[CUSTOMER][NEUTRAL] I'm not gonna go back for years, but I will go back maybe 1 or 2 or 1 or 2 years.
[AGENT][NEUTRAL] Uh, if you stumble across anything because I mean I think your first policy with us it was a [PII] so I mean if you stumble across anything it wouldn't hurt.
[CUSTOMER][POSITIVE] Wow.
[CUSTOMER][POSITIVE] For real? I'm serious. OK. I really appreciate your help and now I have a better understanding of what exactly I'm holding on to.
[AGENT][NEUTRAL] Yeah
[AGENT][POSITIVE] Oh yes. It, it, it is very confusing, trust me, but um I did send you this policy. If you have any other questions, anything you're not sure about, don't hesitate to give us a call back so we can help you out.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Sounds good. And your name again was?
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] [PII]. OK. Great. Thank you so much for your help.
[AGENT][NEUTRAL] Yeah
[AGENT][POSITIVE] You're very welcome thanks for giving us a call. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] You too. Thank you. Bye-bye.
[AGENT][POSITIVE] Thank you bye bye.