AccountId: 011433970860
ContactId: f6e05eab-00b9-4e8d-a814-d2aed009a388
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 292459 ms
Total Talk Time (AGENT): 170279 ms
Total Talk Time (CUSTOMER): 92570 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/14/f6e05eab-00b9-4e8d-a814-d2aed009a388_20250314T14:17_UTC.wav
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[AGENT][NEUTRAL] Good Morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Oh yes, I was calling about my benefits uh to see uh if a particular procedure is covered.
[AGENT][POSITIVE] OK, sure. I can assist you with benefits. May I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] My name is [PII] and my call back number is [PII].
[AGENT][NEUTRAL] Thank you, Ms. [PII]. And may I have the policy number?
[CUSTOMER][NEUTRAL] OK. That will be 122.
[CUSTOMER][NEUTRAL] 4175.
[CUSTOMER][NEUTRAL] M L
[AGENT][NEUTRAL] OK, thank you. And may I have your date of birth, mailing address and email address for verification?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] Perfect, thank you.
[AGENT][NEUTRAL] Alright, so let me pull your benefits and what type of service is being rendered, Ms. [PII]?
[CUSTOMER][NEUTRAL] Well, a mammogram and an MRI.
[AGENT][NEUTRAL] Is the mammogram a uh diagnostic mammogram or preventative mammogram?
[CUSTOMER][NEUTRAL] Preventative.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So the preventative mammogram is not covered because we do not cover preventative service. That's usually cover 100% by the major medical and that's the reason we do not pay for that. Uh, now, the MRI, the MRI is gonna be a diagnostic testing.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So let me go ahead and get the benefit for that one, OK? And this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer. And this is your secondary policy. So we help with the deductibles, co-payment, and co-insurance from your major medical and we do have an MRI which is the diagnostic testing on these benefits, um, for the outpatient maximum of 250 per day, so that will be the benefit amount to 50.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] OK, because it seemed like it wasn't accepting you guys' card, so I should have a remaining balance of $50 because they say I owe $300 so I should have a a uh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] A co-pay of only 50 if y'all gonna pay $250 correct?
[AGENT][NEUTRAL] Yeah, uh, correct, we cannot process anything over the phone and I can only give you benefits, but your benefit amount is $250. So if they're charging you $3 then yes, you will be probably responsible for that $50. Um, did they say they're gonna send in the claim for you or you have to pay out of pocket and send your own claim?
[CUSTOMER][NEGATIVE] Uh, apparently there wasn't um accepting you guys' card. I don't know why.
[AGENT][NEUTRAL] Mhm. OK.
[CUSTOMER][POSITIVE] They accepted my insurance.
[AGENT][NEUTRAL] Yeah, there is some um places that they don't have a way of having a secondary insurance put in their system, and that's the reason they will not take it. Uh, they will not take a secondary policy, um, but you can check with them and see if, um if that's the case or if they're gonna call us to get benefit information or how they can help you process with your secondary.
[CUSTOMER][NEUTRAL] OK, let me ask you this if they don't do that, I can pay and then get reimbursed?
[AGENT][NEUTRAL] If you have to pay out of pocket, you will have to submit your own claim for reimbursement, yes.
[CUSTOMER][NEUTRAL] OK. That's all I wanna know.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm. And Ms. [PII], if you're gonna send in for reimbursement, just make sure to get an itemized bill with diagnosis post by the time you um finish the, the.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] To the MRI, OK?
[CUSTOMER][NEUTRAL] OK. And let me ask you again about the um the mammogram. You say um one is preventative and the other one was what now?
[AGENT][NEUTRAL] The MRI is diagnostic and the mammogram is preventative. We only cover diagnostics. So if there is like a problem, if there is um if they're trying to probably do surgery or if they find something, it becomes diagnostic, um, but if it's a preventative yearly mammogram, then that's not covered.
[CUSTOMER][POSITIVE] Oh, OK. That's what I want. All right, thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You're welcome. Is there anything else I can help you with today, Ms. [PII]?
[CUSTOMER][NEUTRAL] No, that would be it.
[AGENT][POSITIVE] OK, well, thank you for calling ATL. Have a good day.
[CUSTOMER][NEUTRAL] You too now bye bye.
[AGENT][POSITIVE] Thank you, bye bye.