AccountId: 011433970860
ContactId: f4a2db42-c5f0-443b-83e3-408a19fea917
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 347220 ms
Total Talk Time (AGENT): 209535 ms
Total Talk Time (CUSTOMER): 136756 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/f4a2db42-c5f0-443b-83e3-408a19fea917_20250219T16:42_UTC.wav
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[AGENT][NEUTRAL] ATL, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I think I pressed the wrong extension. I need for me link.
[AGENT][NEUTRAL] Yes, that's it.
[AGENT][NEUTRAL] How can I help?
[CUSTOMER][NEUTRAL] OK. All right. OK. So, um, I have my main insurance and then I have APL and I was just wondering, um, would that cover my chiropractor visit?
[AGENT][NEUTRAL] Well, let's look at your policy. Um, I can certainly help with that, and I'm sorry, I didn't catch your name.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK, thank you. And what is your policy number, please?
[CUSTOMER][NEUTRAL] Um, is that the group number or another number?
[AGENT][NEUTRAL] Well, it might be listed as um
[CUSTOMER][NEUTRAL] Is it a 0?
[AGENT][NEUTRAL] Outpatient or inpatient. Um, I know those cards are kind of, there's like two numbers that are exactly, yeah.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] I have 01867071.
[AGENT][NEUTRAL] I'm sorry, you said 018.
[AGENT][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] 67071
[AGENT][POSITIVE] 71. That's perfect. Thank you. Yes, ma'am.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] OK, alright, because I have a group number as well.
[AGENT][NEUTRAL] Oh, no, I think I can get it with this. And then if I could just verify uh your date of birth, please, ma'am, and a, uh, phone number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And my number is [PII].
[AGENT][POSITIVE] Perfect. Thank you so much. So. So, uh, first of all, your, your policy is active and for outpatient services such as the chiropractor, we will pick up your deductible, co-payment or co-insurance to $500 per calendar day. So, um,
[AGENT][NEUTRAL] Uh, if you are going to the chiropractor now, uh, all you would need to do is just give them both of your cards, um,
[AGENT][NEUTRAL] Uh, then, uh, you know, we, that they will file through your major medical first and then they'll file through us and we will pick it up at $500.
[CUSTOMER][NEUTRAL] So that, OK, so, so.
[CUSTOMER][NEUTRAL] So let me just say this. Um, when I went there,
[CUSTOMER][NEUTRAL] Out of pocket I mean I paid for this separate for the consultant um.
[CUSTOMER][NEUTRAL] They told me that I'm not in network.
[CUSTOMER][NEUTRAL] So does that make a difference?
[AGENT][NEUTRAL] Well, uh, yes, um, it does, but let's just say, uh, let's look at it this way. Sometimes your major medical will have benefits for out of network services sometimes. So one of the things that you can do, um,
[AGENT][NEUTRAL] Did they take your insurance at all? Did they even, uh, did you?
[CUSTOMER][NEUTRAL] So, they said no.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] But, but again, so here's the thing, and this is, I, I find it a little bit strange because I, what I do know I maybe I need to check with my HR department, um, I know that for a lot of things they, even if you pay out if you're out of network, you can still reimburse you can get reimbursed after the service, you know what I mean?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] But the broker said no so I'm like really confused. I'm gonna, you know, let me first reach out to my HR department.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And then go from
[AGENT][NEUTRAL] Go from there, yes. And then, um, so, so if I'm understanding correctly, um, the chiropractor didn't even take your insurance card at all, right? They just said out of network and
[CUSTOMER][NEGATIVE] Correct, it didn't take my main, my main, my primary insurance, no.
[AGENT][NEUTRAL] OK, so what we can do, I think the first step that you would need to do is find out if you have out of network benefits. So sometimes what they'll do is they'll give you reduced benefits and there will be and what we're looking for um from APL's point of view, from, from us, from our point of view, what we're looking for is if there's a deductible, co-payment or co-insurance from your insurance. So let's just say uh just the the best case scenario.
[CUSTOMER][NEUTRAL] Right, right, right.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Um, they decide that you have out of benefits, out of network benefits, and they provide you with a, we go ahead and get some, it gets filed either by you or by the chiropractor through your major medical and you get an explanation of benefits that says this is out of network, but we're gonna get, but we're gonna put this much towards your deductible, co-payment or co-insurance anyway.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] That's when you will file through us. Now we do have um uh and we do have a, a uh um online service center uh or you can mail it in or fax it in one way or the other you can get that EOB to us uh and then we can start um paying that deductible co-payment or co-insurance, but the very first step in this whole process is to get your major medical.
[AGENT][NEUTRAL] Get it filed through your major medical first. It must go through your major medical first. So you, I, I would talk to, I would talk to your major medical, see if there's any way that you can file these, you know, that's, um, or, or, or, you know, if we can get the chiropractor to file them, you just send them in, um, you know, and uh then we can just start the process there, um.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Right, right.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And then we'll look at, then, yeah, the chiropractors are covered under your policy with us, but you have, you have to go through them for you have to go through your major medical first.
[CUSTOMER][NEUTRAL] So, OK, so
[CUSTOMER][NEUTRAL] Right, I understand that. So let me ask you this, if
[CUSTOMER][NEUTRAL] Major medical will not give me anything back no matter what it is through a major medical, I can't apply for APL to do that. Is that correct? Oh OK. OK. All right, great. Just answer it now.
[AGENT][NEUTRAL] No, ma'am. That, that is correct. That is correct. We're only useful to you if, if we can go through your major medical.
[CUSTOMER][POSITIVE] OK, got you, thank you so much.
[AGENT][POSITIVE] OK, if there's nothing else I can help with, and thanks for contacting ATL. Have a very good.