AccountId: 011433970860
ContactId: d4609498-f847-4968-b124-38a6e0654c3b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 288480 ms
Total Talk Time (AGENT): 105013 ms
Total Talk Time (CUSTOMER): 156077 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/25/d4609498-f847-4968-b124-38a6e0654c3b_20250625T16:32_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi, [PII]. I need some information. I was, um, I was in the hospital for, for 3 days and um
[CUSTOMER][NEUTRAL] I was just looking to see how do I submit a claim? Does the hospital contact you for the claim? Or do I have to submit the claim? How does that, how does that go about?
[AGENT][NEUTRAL] Generally, the easiest way is if you provide the hospital with your medical card and then they just submit the claim on your behalf.
[CUSTOMER][NEUTRAL] All right, because I don't see that that was done.
[CUSTOMER][NEUTRAL] Cause I went into my chart with the hospital and I, I, I think they just charged my, my primary insurance, not the gap insurance, so.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I need to contact them and let them know, correct?
[AGENT][NEUTRAL] You, yeah, you can contact them and just let them know that you have a secondary and to run it through that. If they refuse, then you can definitely file it yourself. You would just do that either online or you can submit it via fax, but it's definitely easier if they'll do it for you.
[CUSTOMER][NEUTRAL] OK, all right, now let me ask you a question because I'm a little bit confused with my, with my benefits. I believe it's.
[CUSTOMER][NEUTRAL] What is the, the, the, the maximum I get per confinement, how much is that?
[AGENT][NEUTRAL] I would need to look at your policy. Do you have your policy number?
[CUSTOMER][NEUTRAL] I have my group number. I have my payer ID number, and I have my certification number.
[AGENT][NEUTRAL] What's the certificate number?
[CUSTOMER][NEUTRAL] It is 02599267 M as in Mary, L as in love 7.
[AGENT][NEUTRAL] Thank you. And then if I can get your name and date of birth, please?
[CUSTOMER][NEUTRAL] It's [PII], [PII].
[AGENT][NEUTRAL] Thank you, Ms. [PII]. And then lastly, will you please verify the physical address that we should have on file.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, so your plan has an inpatient benefit max and then an outpatient. Inpatient is defined as being in confinement for 18 hours or longer. The benefit max on that is $5000.
[AGENT][NEUTRAL] And then outpatient your benefit max is per calendar day, so every calendar day you have a limit of $300.
[CUSTOMER][NEUTRAL] OK, so let me ask you a question. So I was in the hospital for 3 days.
[CUSTOMER][NEUTRAL] And um they ran tests and they, you know, they, they did all that they had to do. So my, my primary insurance will cover some of it. What's left, that's why I have the gap insurance would be covered.
[CUSTOMER][NEUTRAL] But, but you know how how can I explain, you know how hospitals, they send you a bill and, and it's um
[CUSTOMER][NEUTRAL] It's like different, different areas. Oh, how can I explain it to you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hold on, let me go into
[CUSTOMER][NEUTRAL] So like, you know, I'm looking at my Blue Cross Blue Shield and they'll say, well, you know the date of service when you were in the hospital, um, they covered a portion of it and it's $102 and you have to pay $102 but then they did another test and you have to pay $70. Do you pay that that difference that I need to pay for those services that I had when I was confined in the hospital? Am I correct?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] So yes, your plan picks up any deductible, co-pay or co-insurance that isn't covered by your primary. So the entire duration of your stay in the hospital, whatever was done would fall under the inpatient. So we're going to pay up to $5000 for that stay. We're not gonna pay over that.
[CUSTOMER][POSITIVE] You know what, you just made my day and you're my favorite person.
[AGENT][NEUTRAL] So,
[CUSTOMER][POSITIVE] I love that news, so I don't have to worry about, OK, but I should call, I should call the hospital and let them know about the gap insurance so they can send it directly to you, correct?
[AGENT][NEUTRAL] Right, exactly, because then if they're submitting the claims, then the payment's going to them and they're being reimbursed, yeah.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Perfect. Great. Thank you so much, ma'am. I really appreciate your help. You have a great day.
[AGENT][POSITIVE] You're welcome, [PII]. You too. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.