AccountId: 011433970860
ContactId: fe0c4208-26a8-40bb-9592-d764bab19e3f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 515200 ms
Total Talk Time (AGENT): 254711 ms
Total Talk Time (CUSTOMER): 133516 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/fe0c4208-26a8-40bb-9592-d764bab19e3f_20250305T15:15_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I'm trying to find out if the service is covered or not. Would you be the correct person to talk to?
[AGENT][POSITIVE] Yeah, I'm happy to help and check and see if that's covered. Do you have the patient's policy number?
[CUSTOMER][NEUTRAL] Well, I am the patient.
[AGENT][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Um, am I calling the wrong number?
[CUSTOMER][NEUTRAL] Um, yeah, I can give you my 02588448.
[AGENT][POSITIVE] Alright, thank you so much let me pull this up here one moment.
[AGENT][NEUTRAL] And then if I could please have your first and last name and date of birth.
[CUSTOMER][NEUTRAL] [PII] uh [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And then the last thing I need for security is just your address and email address, please.
[CUSTOMER][NEUTRAL] Um [PII], and then [PII].
[AGENT][POSITIVE] Thank you so much. All right. So I've got your policy pulled up here. Um, what kind of questions or concerns did you have today?
[CUSTOMER][NEUTRAL] I want to see a therapist and I wanna see if that is covered.
[AGENT][NEUTRAL] OK, let's see because some of these plans I know.
[AGENT][NEUTRAL] Do not cover office visits. So let's see, uh.
[CUSTOMER][NEUTRAL] It did not say offices, but it did say mental health that it covered, so I was confused.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yeah let me see if I see anything. I'm just looking at the policy here. I appreciate your patience.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] Let's see here.
[AGENT][NEUTRAL] Where the exclusions are.
[AGENT][NEUTRAL] OK, yeah, so I don't see anything in the limitations or exclusions that leads me to believe that it's not something that would be covered. I don't see anything that says like a physician's office visit fee would not be covered. Generally they'll state that in black and white if it's not gonna cover anything of that nature. So based off of what I can see, [PII], this would pick up whatever your primary doesn't. So we're just gonna pick up the remaining after the primary.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Does that make sense?
[CUSTOMER][NEUTRAL] OK, I know that primary doesn't really cover it. There's no like co-payment on it until I meet my deductible. How does that?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] I mean, honestly, I know uh treatment of a mental or emotional disorder performed in a hospital outpatient facility or outpatient psychiatric treatment facility or a physician's office.
[AGENT][NEUTRAL] Right, so your outpatient benefits on your plan through us um are a calendar day, so your maximum allotment is per day on your plan and that's up to $500 so.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Um, this will cover the deductible, co-pay, or the co-insurance for the primary up to 500 a day. So if your primary is not really covering anything on the initial visit until the deductible, then.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] If the amount is over 500, we would just pay the $500 towards that deductible and then the next visit, whatever the, you know, remaining would be then towards the deductible till that was wiped out.
[CUSTOMER][NEUTRAL] OK, I mean, I think it's, uh, I don't know in the like $100 or $200 so, so how does that work? Do I submit this card to them or how does that work?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Honestly, the easiest way, [PII], if they'll do it for you is, yeah, definitely just provide them your insurance and say, hey, this is my primary, but I also have this as a secondary, and then if they can build both insurances, that's the easiest.
[AGENT][NEUTRAL] If they're not um able or willing to do that, then you can submit the claim yourself um it needs to go through your primary insurance first and then you would submit whatever is remaining to us and claims through us can be submitted online we have like an online portal or they can be done also um via fax or mail so if you'd like that information I can give that to you also.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I mean, do you have it on, I can, I mean I can do it online that's fine. Does it, do you have an app that I do that or no?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It's not an app, it's just um our web address, but if you would like [PII], if it's easiest, I can send you an email with like a user guide on how to set that up. Would that be?
[CUSTOMER][NEUTRAL] The what?
[CUSTOMER][NEUTRAL] Um, yeah, I was just trying to see if I logged in. What is the web address? Just maybe I logged in already.
[AGENT][NEUTRAL] The web address is AM.
[CUSTOMER][NEUTRAL] I was the kid public talk.
[AGENT][NEUTRAL] [PII]. Mhm.
[CUSTOMER][NEUTRAL] OK, so I must have already set up my account.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK and then just upload the files there, OK.
[AGENT][NEUTRAL] Mhm and so you would need a claim form, [PII] and for that it would be the med link claim form um and those are actually on our website under claims and forms.
[CUSTOMER][NEUTRAL] Oh yeah, but it makes you sign in again is that.
[CUSTOMER][NEUTRAL] Is that what it does?
[AGENT][NEUTRAL] Well, you should just be able to click on claims and forms and hopefully it takes you down to the list of claim forms.
[CUSTOMER][NEUTRAL] I click on it and tells me to.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I tell you.
[CUSTOMER][NEUTRAL] Fine. And it gives me the
[CUSTOMER][NEUTRAL] It asked me to sign in and register again, um, mail paper form download and complete the appropriate forms, accident claims.
[CUSTOMER][NEUTRAL] Do I, is this where I just download the form?
[AGENT][NEUTRAL] Yeah, you can download the form there and they're all in alphabetical order, so I think the med link form is on page 2.
[CUSTOMER][NEUTRAL] OK, and then, OK, I see it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it'll give you instructions on page one if you're gonna submit it yourself it'll tell you exactly what you need to submit with the claim and everything also.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][POSITIVE] OK, fantastic.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Great. Anything else I can help you with?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] All right, well thanks for calling APL Katie. I hope you have a good day.
[CUSTOMER][NEUTRAL] OK, yeah. Do you need an itemized bill with diagnosis from the provider? What is that?
[CUSTOMER][NEUTRAL] You just needed to say exactly what what we're doing.
[AGENT][NEUTRAL] Yeah, so it needs to be an itemized bill meaning what the charges are for and um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So with diagnosis from the providers, so they, if you state that to them, there's CPT codes, these codes that they provide for us and that's how we, we know uh what the charges and billing are for.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, fantastic. Thank you so much.
[AGENT][POSITIVE] You're welcome. Have a nice day.
[CUSTOMER][NEUTRAL] OK bye.