AccountId: 011433970860
ContactId: f3dc11d6-2068-4997-82af-2be32cc3342a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 244500 ms
Total Talk Time (AGENT): 110076 ms
Total Talk Time (CUSTOMER): 106771 ms
Interruptions: 0
Overall Sentiment: AGENT=2.5, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/f3dc11d6-2068-4997-82af-2be32cc3342a_20250117T18:24_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, hi, um, I was wondering if an MRI.
[CUSTOMER][NEUTRAL] For my wife for a breast cancer screening.
[CUSTOMER][NEUTRAL] Um, the out of pocket was covered with our insurance here with our supplemental insurance.
[AGENT][POSITIVE] Can I have your name and the policy number and I'll be able to assist you.
[CUSTOMER][NEUTRAL] Yep, the policy number.
[CUSTOMER][NEUTRAL] Uh, I'm assuming you want the outpatient benefit er number, correct?
[AGENT][POSITIVE] Yes, please, sure.
[CUSTOMER][NEUTRAL] Alright, 0 025.
[CUSTOMER][NEUTRAL] 024.
[CUSTOMER][NEUTRAL] 28
[CUSTOMER][NEUTRAL] M as in Mary, L as in Larry 8.
[AGENT][NEUTRAL] And can I have your name, mailing address, and your date of birth?
[CUSTOMER][NEUTRAL] Yep, uh, name is [PII]. The mailing address [PII].
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Date of birth [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And [PII], what is the email address that we have on file for you?
[CUSTOMER][NEUTRAL] Yeah, it should be [PII].
[AGENT][NEUTRAL] The callback number is [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] You're calling to verify if mammograms are covered under the policy.
[CUSTOMER][NEUTRAL] Uh, well, it, it, it's an, uh, yeah, MRI for breast cancer screening, so.
[CUSTOMER][NEUTRAL] I think that's a that's the same thing as well right.
[AGENT][NEUTRAL] So this policy has diagnostic testing.
[AGENT][NEUTRAL] This falls under your outpatient benefits?
[AGENT][NEUTRAL] Of $4000 per calendar year and this is not a guarantee of benefits just a disclaimer of the policy's coverage.
[CUSTOMER][NEUTRAL] So I'm sorry I missed I missed the the first part of what you said. What did you say?
[AGENT][NEUTRAL] Your policy has an outpatient benefit of $4000 per calendar year for diagnostic testing, and this is not a guarantee of benefits, just a disclaimer of the policy's coverage.
[CUSTOMER][NEUTRAL] I understand so for um outpatient diagnostic screening if we have an an out of pocket portion.
[CUSTOMER][NEUTRAL] Um, it's not a guarantee, but diagnostic services are covered under this, correct?
[AGENT][POSITIVE] Yes, that is correct. Now if she has, if it's a go ahead.
[CUSTOMER][NEUTRAL] And is that some
[CUSTOMER][NEUTRAL] No, go ahead please.
[AGENT][NEUTRAL] So if she, if the screening, sometimes screenings are not covered under the policy due to the primary covering the screening because it's a preventative services. However, if it's a sickness, she's getting an MRI due to a sickness because it's a possibility that she may have breast cancer. I'm not sure what the diagnosis is. However, it would be covered if it's a sickness, if she has cancer or something.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And in this case it's a it's a uh it's a screening so does the um provider.
[AGENT][NEUTRAL] The screaming itself.
[CUSTOMER][NEUTRAL] Submit the claim to you or do we go and pay for, you know, any deductible or anything out of pocket and then submit it um ourselves?
[AGENT][NEUTRAL] So the provider to submit the the provider to submit the claim, I think it'll be less of a headache for the insured if the provider submits the claim. However, if you decide to submit the claim on your own behalf, then you would need the EOB, which is the explanation of benefits from your primary insurance company, and you will also need the itemized bill from the facility showing the diagnosis codes for that date of service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, understand. I appreciate it.
[AGENT][POSITIVE] You're welcome. Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][POSITIVE] That's all for now thank you.
[AGENT][POSITIVE] Thanks for calling ATL and have a great day.
[CUSTOMER][POSITIVE] Thank you.