AccountId: 011433970860
ContactId: c63c0a51-e285-44a6-8366-973f67084546
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 397739 ms
Total Talk Time (AGENT): 157436 ms
Total Talk Time (CUSTOMER): 184028 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/c63c0a51-e285-44a6-8366-973f67084546_20250204T20:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII], and the purpose for this call is I do have a Medins summary benefit, and as I was going through it, I saw they cover MRI facility, so I wanna see, I did a MRI and I wanna see if it was covered.
[AGENT][NEUTRAL] I'll be happy to verify benefits. May I have your policy number?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Um, I don't have a policy number because it's on my payroll I buy it.
[AGENT][NEUTRAL] May I have your social security number?
[CUSTOMER][NEUTRAL] Sure. [PII].
[AGENT][POSITIVE] Thank you. May I have a good callback number?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] Can you verify your date of birth, your mailing address, and your email, please?
[CUSTOMER][NEUTRAL] Sure, um, [PII], mailing address [PII] and um address is, uh, [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. Please be advised that verification of coverage does not guarantee the payment of a claim. Would you like your policy number?
[CUSTOMER][POSITIVE] I'm sure, thank you.
[AGENT][NEUTRAL] Yes, it's 0240.
[CUSTOMER][NEUTRAL] 02.
[AGENT][NEUTRAL] 406 5.
[CUSTOMER][NEUTRAL] 40
[CUSTOMER][NEUTRAL] Sorry, 426 5.
[AGENT][NEUTRAL] OK, let's start over. 02.
[AGENT][NEUTRAL] 40.
[AGENT][NEUTRAL] 658-7.
[CUSTOMER][NEUTRAL] 658-7. OK, got it.
[AGENT][NEUTRAL] Yes, ma'am. And so under this plan, the MRI will fall under your outpatient calendar year benefit amount of $1000.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So it will pick up your copays, your co-insurance, and our deductibles up to the $1000.
[CUSTOMER][NEUTRAL] OK. So, for example, if I, I think the claim was $300. Um, 300, where is it? Where? I just saw it. Um, I'm in my Aetna profile.
[CUSTOMER][NEUTRAL] 307-62. So, how does that work? Like, for example, if I have to do another procedure later in the year, the difference is what I can claim or once you make one claim, that's it?
[AGENT][NEUTRAL] No, ma'am, it will process your copays, your co-insurance, and or deductible up to that benefit amount. So as the claims come in, they will process according to your primary insurance, the co-pays, the co-insurance, and our deductibles, which total up to $1000.
[CUSTOMER][NEGATIVE] Jeez, I wish I knew that I would do 1500 instead.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And when I select my plan, I had no idea that this is a nice plan because you never know um how do I file file for this?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] You can either have your provider file or you can obtain your primary insurance explanation of benefits.
[AGENT][NEUTRAL] An itemized bill.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] You would need a Metlink claim form.
[CUSTOMER][NEUTRAL] OK, I see.
[AGENT][NEUTRAL] And you can submit them yourself.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, because I don't pay it because as I said, I didn't know I was covered.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So I'm going to, so where I'm a little confused with how I get the details for this because it's a MRI.
[AGENT][NEUTRAL] OK, so if you've already had the service, you can get a bill from your doctor.
[AGENT][NEUTRAL] And then your primary insurance?
[AGENT][NEUTRAL] They usually have a website where you can go online to obtain that major medical explanation of benefits.
[AGENT][NEUTRAL] Or you can contact.
[CUSTOMER][NEUTRAL] Primary insurance. I am in it, I am in it now.
[CUSTOMER][NEUTRAL] Right now, but I don't see, if I click on the claim, I don't see anything.
[AGENT][NEUTRAL] Did you just have your MRI? Maybe they have not submitted it to your insurance yet.
[CUSTOMER][NEUTRAL] Oh no, it's here. I see it here.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] That's how I, I realized I was looking at the benefits and then I said, what the heck, I didn't even know. Is there a timeline you have to file this?
[AGENT][NEUTRAL] No, ma'am, there's no timeline.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But what you said that there is a, maybe in the claims part I can see the, the details?
[AGENT][NEUTRAL] You will need an itemized bill from the provider for that.
[CUSTOMER][NEUTRAL] Of this?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then you would need the Metlink.
[CUSTOMER][NEUTRAL] OK, so I guess the
[AGENT][NEUTRAL] Claim for.
[CUSTOMER][NEUTRAL] Mean uh form.
[AGENT][NEUTRAL] Yes, ma'am. It's Medlink Claim form.
[CUSTOMER][NEUTRAL] And where do I get that metaling form?
[AGENT][NEUTRAL] You can go to [PII].
[AGENT][NEUTRAL] And go under forms and you can receive your Metlink claim form.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] OK, perfect. This is such good info and um.
[CUSTOMER][NEUTRAL] All right, appreciate it and effective when did I have this policy? I think it's October or something.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh no, I wish I knew I could have, I just, just set this up. I could have um.
[CUSTOMER][POSITIVE] Anyway, thank you so much, ma'am. This is great info.
[AGENT][POSITIVE] You're so welcome.
[CUSTOMER][POSITIVE] I appreciate your help.
[AGENT][NEUTRAL] Is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] OK, bye bye.
[AGENT][POSITIVE] Thank you for calling American Public Life. Have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] No, that's all thanks.
[CUSTOMER][POSITIVE] No problem bye bye you too bye. Oh gee.