AccountId: 011433970860
ContactId: d64b5fc6-873c-4d84-8777-cdd5f393111d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 382869 ms
Total Talk Time (AGENT): 173082 ms
Total Talk Time (CUSTOMER): 138262 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/25/d64b5fc6-873c-4d84-8777-cdd5f393111d_20250625T12:47_UTC.wav
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[AGENT][NEUTRAL] APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hey how are you? I had a couple questions about my insurance.
[AGENT][POSITIVE] Sure, I can assist you with that. Can I have your name and the callback number?
[CUSTOMER][NEUTRAL] Um, my name, my name is [PII].
[AGENT][NEUTRAL] And what is your policy number?
[CUSTOMER][NEUTRAL] My policy number.
[CUSTOMER][NEUTRAL] Uh, that's my group number?
[AGENT][NEUTRAL] No, it should say policy or certain number.
[AGENT][NEUTRAL] What's your social?
[CUSTOMER][NEUTRAL] Um, OK, sorry, sorry, it says here in hospital benefits cert number.
[AGENT][NEUTRAL] Yes, this will be your policy number. Either one of them.
[CUSTOMER][NEUTRAL] Or outpatient.
[CUSTOMER][NEUTRAL] OK. All right, thank you. Uh 02570055 M as in Mary, L as in Larry 7.
[AGENT][NEUTRAL] Uh, could you verify your mailing address and your date of birth?
[CUSTOMER][NEUTRAL] My date of birth is [PII] and my mailing address is [PII].
[AGENT][NEUTRAL] And what is the email address that we have on file for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] We have something else could you verify what we have and then I can change it for you if you would like.
[CUSTOMER][NEUTRAL] Uh, it could be [PII].
[AGENT][NEUTRAL] Yes, that's what we have. Would you like for me to change that?
[CUSTOMER][NEUTRAL] Um, yeah, you can change it to my email actually, yeah.
[AGENT][NEUTRAL] OK, so what do you want me to change it to?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] [PII], yes.
[AGENT][NEUTRAL] Mhm. It's [PII], right?
[CUSTOMER][NEUTRAL] Yeah, [PII]
[AGENT][NEUTRAL] And what is your callback number just in case the call is disconnected [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And how can I assist you today? today you're calling about your benefits. How can I assist you?
[CUSTOMER][NEUTRAL] Um, so I'm getting an MRI on Friday.
[CUSTOMER][NEUTRAL] And I just wanted to double check that um my gap coverage uh covers um the MRI.
[AGENT][NEUTRAL] So you wanna verify your outpatient benefits and look.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] So you have outpatient benefits of $6000 per calendar year and this is, this includes diagnostic testing, and this is not a guaranteed benefits just a disclaimer of the policy's coverage.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][POSITIVE] Great.
[CUSTOMER][NEUTRAL] What is diag diagnosis benefits?
[AGENT][NEUTRAL] And what were you about to ask?
[AGENT][NEUTRAL] Diagnostic testing is the MRI. That's the diagnostic testing.
[CUSTOMER][NEUTRAL] Oh, OK, great, and then the next thing would be.
[AGENT][NEUTRAL] That is considered as diagnostic testing.
[CUSTOMER][POSITIVE] All right, I'm learning a lot today. This is, this is good, um.
[CUSTOMER][NEUTRAL] Uh, another thing, so when, when I, when I go to do the MRI, I pay for the testing out of pocket and then I send you guys the bill or how does that, how does it, how do I get reimbursed?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] No, so I'm not sure how they do it at the office, but you should be able to provide them with both of your insurance cards with your primary insurance card and the Metlink card, which will be your secondary insurance.
[CUSTOMER][NEUTRAL] OK, which is the one I'm calling about?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK. And then how would it work for um phys physical therapy, the co-pay for physical therapy?
[AGENT][NEUTRAL] Physical therapy falls on your outpatient benefits as well.
[CUSTOMER][NEUTRAL] And um if I already paid for like the sessions of physical therapy, can I get reimbursed? Or would that have to be like you said again? Yeah.
[AGENT][NEUTRAL] You can.
[AGENT][NEUTRAL] You can be reimbursed, however, you will have to submit an itemized bill, like a UB or 1500 form, including the diagnosis codes with your explanation of benefits from the primary insurance company showing what went towards your deductible co-pay and your co-insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, great, um, and where would I find those forms?
[AGENT][NEUTRAL] And let me know if you didn't, so you will have to contact the facility to request the itemized bill listing the diagnosis codes. So make sure that you express that you need an itemized bill listing the diagnosis codes for each data service that you've already.
[AGENT][NEUTRAL] They've already completed and then also you will have to contact your primary insurance company to request an itemized bill, I mean a um explanation of any benefits. It's called an EOB or you can go online and retrieve the EOBs for those dates of services, but you definitely will have to have both of those items that are listed, including the diagnosis code on the itemized bill.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so explanation of benefits from a primary insurance and then an itemized what?
[AGENT][NEUTRAL] An itemized statement, an itemized bill from the the facility. It could be a UB or 1500, depending on how they submitted it to the insurance company.
[AGENT][NEUTRAL] So you can contact them and say, hey, I need a UB or 1500 to submit to my secondary insurance for services that I've already paid for and I want to be reimbursed.
[AGENT][NEUTRAL] And they don't know what you're speaking of.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, perfect. OK, I think this is that.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][POSITIVE] No, that's it you've been very helpful. I appreciate it thank you very much.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL and you have a great day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thanks, goodbye.