AccountId: 011433970860
ContactId: 01e1ec86-8b06-43ed-b6c6-d631e5d73259
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 360799 ms
Total Talk Time (AGENT): 191971 ms
Total Talk Time (CUSTOMER): 152596 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/01e1ec86-8b06-43ed-b6c6-d631e5d73259_20250620T14:54_UTC.wav
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[AGENT][POSITIVE] Thank you for contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], good morning. My name is [PII], and I, I currently, I currently have um a policy, um, with APL.
[CUSTOMER][NEUTRAL] And I just have a, uh, I have a question I'm not I'm hoping you can answer that for me, um.
[CUSTOMER][NEUTRAL] So, um, there's this procedure that that I'm I'm probably gonna have done and I wanted to see how, um, I, I know that I, I have a like with my insurance with, uh, United Healthcare I have a, a $2500 I have to meet the 2500 that $2500 copay thing but then APL, uh, from what I understand it, APL also pays for part of that, uh, procedures. So how does that work?
[AGENT][NEUTRAL] Well, let's look at your policy, uh, Mr. [PII] and find out what is that policy number, sir?
[CUSTOMER][NEUTRAL] Sure, it's uh 01.
[CUSTOMER][NEUTRAL] 369-582.
[AGENT][NEUTRAL] Thank you. If I could verify your date of birth and the phone number, please?
[CUSTOMER][NEUTRAL] Uh, yeah, date of birth is [PII].
[CUSTOMER][NEUTRAL] And my phone number is [PII].
[AGENT][POSITIVE] Thank you very much. So what your policy covers, uh, first of all, it's, it's for accident or sickness and what it will cover.
[AGENT][NEUTRAL] Is outpatient hospital services or inpatient hospital services. So the service that you're getting ready to or the the procedure that you're getting ready to have done, um, is it for accident or sickness, or is this a wellness or is it uh cosmetic or?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Well, it's no, it's not for an accident, um, but it, it's called, uh, it's, they call it an endoscopy, um, um.
[AGENT][NEUTRAL] Oh, yes, OK.
[CUSTOMER][NEUTRAL] Yeah, it, it's like that, um, it's got a long name to it, but it, but the short name is for this endoscopy, but, um, it's where where they they um they install a camera going on to your esophagus, down to your stomach.
[CUSTOMER][NEUTRAL] That I don't know if you're familiar with that, but um it's called gastro gastroenterology or something like that anyway, um, that's what um the pro the procedure that I got approved for um and uh so it's not till next month but I wanted to call ahead in in advance so how does that work with my APL?
[AGENT][NEUTRAL] Yes, sir. I am.
[AGENT][NEUTRAL] OK, so what will happen is, um, you will, uh, you will go ahead and, and, uh, give them your primary insurance card as well as your secondary insurance card, which is the APL, and they will file through your, your primary insurance first and then we will get an explanation of benefits.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And Google pay the deductible, ton, and the car insurance for $1250.
[AGENT][NEUTRAL] Now normally whenever they do something like that, it's because you're having trouble with it.
[AGENT][NEUTRAL] in customs or or there's a reason for it they don't usually do that kind of.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] And so that is the same as the.
[AGENT][NEUTRAL] The only time, the only thing that we don't cover, um, would be if it were for a well if you say the annual checkup, that sort of thing, that sort of thing is not covered on this policy, but they usually don't do this kind of procedure just as a wellness.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] OK, so, OK, so what you're telling me is that it, it's not, it's not gonna, it's not gonna, I can't use it as a, as a supplement to help pay towards my deductible.
[AGENT][NEUTRAL] Please, yes, please submit the, the, the, um, the the, uh, your secondary insurance card at the time that you go to in for the procedure. Yes, sir, and what they will do is they will go ahead and process your primary insurance first and then through to us, but that's what we will do is we will pick that up up to $1250.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, so, OK, so, so they'll process it and at the time and then it'll go towards that?
[AGENT][NEUTRAL] Uh, yes sir, yes, that's what happens. It's, um, so when, uh, and this is for the facility bill, this is for the physician because there's something like this has, has a lot of of of bills that go along with it, a lot of charges, so you'll have a charge just for the, the facility, uh, the outpatient hospital facility that that you're going into. You are going into an outpatient hospital facility, is that, is that correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, yeah, because it's gonna be a one day thing. I'm gonna go home that hello, are you there? Um, I, I mean, I'm gonna, it's gonna be a one, it's gonna, yeah, it's gonna be a one, it's just gonna be the, the procedure and then I'll be released that same day.
[AGENT][NEUTRAL] Yes, sir. Yes, I am.
[AGENT][NEUTRAL] Right, yes, but you usually go to an outpatient hospital facility, right? Like you're not having it done in the physician's office. Is that correct?
[CUSTOMER][NEUTRAL] So I'm
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] No, it's going to be done it's going to be done in the hospital in a hospital.
[AGENT][NEUTRAL] Yes, exactly. That's what, that's what I meant. And so, um, they don't, they don't normally do those, uh, type of procedures, Mr. [PII], unless there's something that, that they're trying to check and so that is why something like this is, is covered because it's actually, uh, there, it's not just a wellness thing, it's not just an annual thing. There's actually something that they're checking on.
[AGENT][NEUTRAL] And that's why they would do this type of procedure. So, what will happen is when you go into uh either the physician's office before the uh sur before the procedure, or when you uh check in at the outpatient hospital facility, give them both parts.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] And then, yes, yeah, yeah, and I'll go ahead and file both of them and yes sir, that's what we will do uh we can get this taken care of.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now is there anything else at all? Yes, sir, is anything else at all that I can.
[CUSTOMER][POSITIVE] OK then uh thank.
[CUSTOMER][POSITIVE] OK, no that, no, that, no, that's you, you've been, you've been wonderful. Thank you for the information and I'll definitely have both cards with me at the time of the procedure. Thank you.
[AGENT][POSITIVE] OK, thank you for contacting ATO have a good day.