AccountId: 011433970860
ContactId: ee122be9-b2d5-4138-a3df-3fc86d81f3db
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 389049 ms
Total Talk Time (AGENT): 192469 ms
Total Talk Time (CUSTOMER): 227320 ms
Interruptions: 6
Overall Sentiment: AGENT=1.1, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/ee122be9-b2d5-4138-a3df-3fc86d81f3db_20250409T17:10_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, good morning or good afternoon. Sorry, my name is [PII]. Uh, initial to my last name is [PII], and I'm calling from the provider's office. Um, this might sound kind of funny, but, um, the patient asked us to give you all a call. I believe this is her, uh, secondary insurance plan, um, and she wanted wanted us to call to see if um she is covered for an exam and if it requires a pre-op.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure. OK. Yeah, absolutely. I can check all of that. Um, so, a specific, um, you said an exam. Is this like an office visit or will she be receiving treatment?
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] No, no, no, she'll have treatment actually it's for uh it's a major exam it's for an MRI. I have a CPT code if you need that.
[AGENT][NEUTRAL] I think
[AGENT][NEUTRAL] No worries. No, no, that's perfectly fine. Um, most MRIs, is this in a physician's office facility though, or is this in a different kind of facility?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, no, actually I'm calling, uh, we, it is an office setting, but we're specialist office, uh, radiology.
[AGENT][NEUTRAL] I see.
[AGENT][NEUTRAL] OK, perfect. Yes, um, so I can definitely get that policy pulled up and make sure that that is covered and see if authorization is required. Um, [PII], first, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Absolutely. Yes, yes. It's [PII], and that's a direct line.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Awesome thank you and then do you have that policy number?
[CUSTOMER][NEUTRAL] I sure do. Um, it is 01642618 M like Mary, L like Larry, and then the number 8.
[AGENT][NEUTRAL] OK and then uh what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Yes, the patient is [PII]. Uh, date of birth is [PII].
[AGENT][NEUTRAL] Perfect thank you so much for verifying that information. Uh, so of course this policy is active. Effective date was [PII], and in short, as this is a secondary medical policy, it is designed to help with co-pay, deductible and co-insurance after major medical pays and is very dependent on major medical, so as long as they are willing to pay this policy can so no authorization is required.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so because uh you know I was trying to explain to her and you know I know she doesn't know, but I was trying to explain to her that typically if you have a primary insurance, uh, whatever the primary doesn't pick up, uh, um, you know, the, the secondary, uh, will pick up, so she wanted to know, I mean.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So I mean she would be covered then uh but just a portion of it because she has a primary but for some reason or other she wanted me uh to call y'all to see if it would be covered um almost like a primary I guess is what she's asking.
[AGENT][NEUTRAL] No, OK, so, um, just so that I understand correctly, I'm sorry, um, her primary, they're gonna be covering all of it?
[CUSTOMER][NEUTRAL] Well, no, actually, no, she wanted me, no, they're not gonna cover all of it. She doesn't want, I guess, um, use, uh, I guess what she's telling me is she doesn't want to use a primary and wanted to use her secondary and this is why I was trying to explain to her, well, look, if you have a primary you have to use your primary but for some I don't know what the reason is, but I said let me just call.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Uh.
[AGENT][NEUTRAL] Sure, yeah.
[AGENT][NEUTRAL] Uh yes.
[AGENT][NEUTRAL] Exactly. Well, and I know.
[AGENT][POSITIVE] Yeah and that's good because I know that a lot of confusion comes in where a lot of people will call this like a gap plan and that's not how it works it cannot be used instead of major medical it is designed Major medical has to pay and this policy helps with if she has co-pays, deductibles, and then co-insurance that's what this plan helps with.
[CUSTOMER][POSITIVE] Exactly.
[CUSTOMER][NEUTRAL] OK, OK, and that's what I, you know, I just wish there was a way I could explain to her. I feel so bad I said let me do my best, let me do my best. So and then I had to explain to y'all, you know, because, um, OK, yeah, and that's what I'm telling her, um, so she, uh, but it wouldn't require y'all will require the pre-ops because y'all are secondary, correct?
[AGENT][NEUTRAL] I, yeah.
[AGENT][POSITIVE] Sure, absolutely.
[AGENT][NEUTRAL] No, absolutely that's correct. Again, uh, if major medical is willing this policy can, um, and I did just check, uh, and of course I will let you know verification of coverage is not a guarantee of payment for claims, um, so treatment received in office is covered, a covered benefit under her outpatient benefit.
[AGENT][NEUTRAL] So her outpatient benefit on this policy pays on a per calendar day basis, so it pays up to $500 per calendar day and again that can go towards co-pay, deductible and or co-insurance.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Alright, and I will go ahead and call her back and explain that to her and can you spell your name for me?
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] Yes, it's [PII] and if you know she's more than welcome to give us a call as well on the same number, you know, and we can do our best to kind of explain it that way.
[CUSTOMER][NEUTRAL] You know, and I mentioned that to her exactly. I mentioned that to her. I go, you can also call member service, but I don't know if it's because she's she's not sure what to ask or or what. I said, well, let me, let me go ahead and call, but I'm gonna go ahead and call her and that way she wants to call y'all, um, um, y'all can go over that with her as well and [PII], can I get the initial?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And we talk to members all the time and yeah yeah it's uh it's a um so but just so that she wears and I know it can be a bit daunting, you know, calling your insurance company might seem like you know maybe she just didn't want to mess with it but it's not generally too painful.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] A
[CUSTOMER][POSITIVE] Exactly.
[CUSTOMER][NEUTRAL] Exactly, yeah, I know.
[CUSTOMER][NEUTRAL] Right, exactly. That's what I told her. So and [PII], is there um a reference number for our call?
[AGENT][NEUTRAL] Sure, yes, it would just be my first name, last initial, and today's date. And did you have any other questions for me, [PII]?
[CUSTOMER][NEUTRAL] No, I don't and can you give me the time that you have there now?
[AGENT][NEUTRAL] Oh sure, yeah, I'm central, so right now it is uh [PII].
[CUSTOMER][POSITIVE] OK perfect yeah we're central too so perfect. [PII], thank you so much uh I will call the patient back and and you know also let her know she wants to call y'all she can.
[AGENT][POSITIVE] Awesome, yeah.
[AGENT][NEUTRAL] Of course.
[AGENT][POSITIVE] Absolutely, yeah, definitely well thanks for giving us a call. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] You as well, [PII], thank you, bye bye.
[AGENT][POSITIVE] Thank you, bye bye.