AccountId: 011433970860
ContactId: cdda1cc0-122e-4b9e-b070-009ee7eb180a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 681950 ms
Total Talk Time (AGENT): 358142 ms
Total Talk Time (CUSTOMER): 222152 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/cdda1cc0-122e-4b9e-b070-009ee7eb180a_20250407T19:11_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, good afternoon, [PII]. Uh, my name is [PII]. I'm calling in because I just
[CUSTOMER][NEUTRAL] I really just want more information about my plan everything that covers it and uh I just had a few questions.
[AGENT][POSITIVE] OK, I'm happy to take a look. Do you have your policy number? I can pull it up.
[CUSTOMER][NEUTRAL] Yes, I believe it says uh it's 02610458.
[AGENT][NEUTRAL] OK, let me pull this up here. Give me just a sec.
[AGENT][NEUTRAL] And then for security, if I can get your first, last name and date of birth.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Excuse me, first name is [PII], last name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you, smear.
[CUSTOMER][NEUTRAL] 052,000.
[AGENT][NEUTRAL] And then the last thing I need to verify, please, uh, is your physical address and email address.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh [PII].
[AGENT][NEUTRAL] All right, thank you. OK. So,
[AGENT][NEUTRAL] The type of plan that you have with us is a secondary medical insurance.
[AGENT][NEUTRAL] And so the purpose of that is really to bridge the gap between your major medical and your out of pocket cost. So we pick up any sort of deductible, co-pay, co-insurance from your primary that's not covered. Uh, so the hope is, is that if you had anything major happen, uh, your out of pocket costs would then just be minimal.
[CUSTOMER][NEUTRAL] OK, so with that being said, I do have a question, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I got into a motorcycle accident right before I could get all my uh insurance from my company which is this is this is how I got this one.
[CUSTOMER][NEUTRAL] Um, and the doctor, well, in the hospital, a lot of things were saying, and even the old nurses were saying that uh.
[CUSTOMER][NEUTRAL] If I get insurance and I talk to them, it may be able to cover some of it if it's uh in the in in the 60 day period, 60 or 90 day period.
[CUSTOMER][NEUTRAL] Um, so I was just, I really just wanted to see if you had any information about that if you knew something like that, you know, happened before and they did cover it or they didn't cover it.
[AGENT][NEUTRAL] Um, let me see.
[AGENT][NEUTRAL] I'll double check, let me pull the policy up. I'm pretty certain that
[AGENT][NEUTRAL] Your effective date on your coverage was [PII]. So, if the date of incident was prior to that,
[AGENT][NEGATIVE] Don't believe it's gonna, it's not gonna be covered. Um, let me see.
[CUSTOMER][NEUTRAL] Yeah, because it was literally maybe uh a few days before the, the [PII].
[CUSTOMER][NEUTRAL] It was, uh, it was actually, it was the day before, uh, or, or the day of, uh, [PII].
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][POSITIVE] And I appreciate you looking man.
[AGENT][POSITIVE] Yeah, no, not a problem.
[AGENT][NEUTRAL] Yeah, so the only time I think like there would be a coverage where maybe that would be applicable would be if it was you were out of work, you know, um, and the policy lapsed due to, you know, premium not being paid, generally we'll, we'll grant like a 30 day uh window for that, but
[AGENT][NEGATIVE] Unfortunately, anything prior to [PII] isn't going to be picked up on this.
[CUSTOMER][NEUTRAL] That's fine then, ma'am. That's, that's all I wanted to, uh, to know, um, and I'm so sorry again I'm, I'm, I'm [PII] so I'm kind of new to this, uh, insurance game uh.
[AGENT][NEUTRAL] No. Yeah, don't apologize if we don't ask questions, we don't get the answers, so don't apologize.
[CUSTOMER][NEGATIVE] Right, right, close mouth, don't get fair, right? Um.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So my next question is you said this was a secondary insurance meaning that I have uh a prior one or a primary one is that uh is that something that I have to take that with uh my company or is it the, the, I, I believe it's uh Florida Blue Cross.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm. I mean, not.
[CUSTOMER][NEUTRAL] Something like that is is.
[AGENT][NEUTRAL] Yeah, so that would.
[CUSTOMER][NEUTRAL] Is that related to you guys?
[AGENT][NEUTRAL] No, that would be if it's, no, that's OK, um, that would be Blue Cross Blue Shield, probably if it's Florida Blue.
[CUSTOMER][NEUTRAL] Sorry.
[AGENT][NEUTRAL] Um, and so any information on that, yeah, you would wanna go to your employer or to that company themselves because we don't have any information on the primary.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, OK, and again I'm just making sure, so secondary you guys only come in.
[CUSTOMER][NEUTRAL] When the primary can't fully take care of it, right?
[AGENT][NEUTRAL] Correct. Like your primary has to pay something for us to pick up anything. If your primary doesn't cover anything, then we won't.
[CUSTOMER][POSITIVE] Alright, well, that's, that's, that's honestly let me know a lot of things, um, well, that's, that's honestly everything that all, all the questions that I have for you guys. I appreciate you picking up the, the phone.
[AGENT][POSITIVE] Yeah, not a problem.
[AGENT][NEUTRAL] If you think of anything else, feel free to give us a call or do you have any other questions you can think of right now?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Uh, well, really just to reiterate, uh.
[CUSTOMER][NEUTRAL] Is there a maximum, is there a max number that I have on this, uh, account?
[AGENT][NEUTRAL] Uh, yeah, there is a limit. Yeah, there is a limit. Let's see what that is.
[CUSTOMER][NEUTRAL] Like a limit?
[AGENT][NEUTRAL] Um, OK. So,
[AGENT][NEUTRAL] The limits on your plan are per occurrence, and what that means per occurrence.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] would be being seen for the same thing. So, if you, for example, broke your arm,
[AGENT][NEUTRAL] Um, your outpatient benefits for a broken arm would be up to $500 for outpatient.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Um, that would be, you know, treatment in a doctor's office, things like that. It's only gonna pay up to $500 for that broken arm.
[AGENT][NEUTRAL] Um, if let's say a week later, then you broke your ankle, then you would have another $500 to start over and use again because this is a different occurrence. You're being seen for something different.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, your inpatient benefit on your plan is $2000. Inpatients defined as being in the hospital, confined for 18 hours or longer.
[AGENT][NEGATIVE] And that's also a poor occurrence. So, example, you had a heart attack, go to the hospital.
[AGENT][NEUTRAL] The plan's gonna pay up to $2000 for that heart attack while you're in the hospital. Um, if you then a year later had a stroke, that would be a different occurrence. You're being seen for something different. Does that make sense?
[CUSTOMER][NEUTRAL] Mm yes. So one more question going off that, uh, if you go, like, for example, when you go to a doctor, right? And let's say I go right now to get my arm checked out cause you know, I just broke it.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Then I go later on the day again to get it checked out because it was still hurting. They'll bill me two separate, uh, bills. Would you guys do the same or that will still be count as one?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It would still be as two separate, but anytime that you see a doctor, facility provider, um, it's very important to let them know that um you have a secondary insurance. So what they would do is like you go initially, they would take your Blue Cross Blue Shield and then take your card from us.
[AGENT][NEUTRAL] And they would bill us for that. When you went back later in the day, they would bill your primary insurance and then ask for that separately. So you always just wanna make sure that you're giving the facilities or doctors uh the primary insurance and let them know that you have secondary.
[CUSTOMER][POSITIVE] OK, well I'm glad I know that thank you.
[AGENT][NEUTRAL] Yeah, yeah. And I always tell people, like, um, I told a lady earlier, like, don't pay anything. Like, let them know, like, OK, yeah, you know, I have such and such for my primary, but this is my secondary. So once you bill my primary and then bill my secondary, then, you know, whatever I'm responsible for, great, you know, but you definitely want both insurances to pay first.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][POSITIVE] OK, that makes sense that makes sense. uh thank you for that tip. I appreciate that.
[AGENT][POSITIVE] Yeah, not a problem.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Other than that, I believe that's that's it. I'm tracking on everything else.
[CUSTOMER][POSITIVE] So yeah I I appreciate you picking up the phone um and then I just have to get in contact with my primary.
[AGENT][POSITIVE] Yeah, not a problem.
[AGENT][POSITIVE] Yeah, absolutely. So yeah, you just wanna let them know that um you have the the primary and then the secondary and if you ever have any questions or concerns on anything, feel free to give us a call.
[CUSTOMER][POSITIVE] Yes ma'am, I appreciate you.
[AGENT][POSITIVE] Yeah, not a problem you have a good rest of your day, OK?
[CUSTOMER][NEUTRAL] You too ma'am bye bye.
[AGENT][NEUTRAL] All right. Bye-bye, [PII].