AccountId: 011433970860
ContactId: 0f598d5b-98b0-467c-980c-4220e3b2927c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 252559 ms
Total Talk Time (AGENT): 88627 ms
Total Talk Time (CUSTOMER): 97841 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/0f598d5b-98b0-467c-980c-4220e3b2927c_20250224T21:34_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, um, I was wondering if you could help me with figuring out whether certain, uh, procedures are covered under my company's plan.
[AGENT][NEUTRAL] OK. And your name is?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK, and Ms. [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Where would it be? Would it be at the bottom of the printout?
[AGENT][NEUTRAL] Of the card, uh, it may say in hospital or outpatient benefit er number or policy slash cert number.
[CUSTOMER][NEUTRAL] Oh no, I haven't even signed up yet.
[AGENT][NEUTRAL] Oh, OK. What's the name of your group or employer?
[CUSTOMER][NEUTRAL] Advisors I [PII] V I S O R.
[CUSTOMER][NEUTRAL] S LLC.
[AGENT][NEUTRAL] on that.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Wait one moment.
[CUSTOMER][POSITIVE] No worries.
[AGENT][NEUTRAL] Lord, I cannot spell type yeah.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] OK. And you said you're wanting to know if certain benefits are covered?
[CUSTOMER][NEUTRAL] Yeah, um, it's, it said exclusions, um, sterilization is one of them, so like, um,
[CUSTOMER][NEUTRAL] Hysterectomy or tubal ligation, etc.
[CUSTOMER][NEUTRAL] Prohibited, right? From being part of that?
[AGENT][NEUTRAL] It wouldn't be covered since it's considered a sterilization. Yes, ma'am.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Got it. Um, if I was in.
[CUSTOMER][NEUTRAL] The surgery because they were doing other things, um, and they had to make a decision.
[CUSTOMER][NEUTRAL] To remove
[CUSTOMER][NEUTRAL] My tubes or remove my uterus, would that be covered then if it started out as something else?
[AGENT][NEUTRAL] It would kind of depend on the diagnosis because usually before the procedure, they have to have the diagnosis, the reason for the tubal ligation, so.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] They can be reviewed, especially, uh, looks like the policies are offered is secondary, so also if it's covered in primary, but we would just have to review the claim and see what the diagnoses are.
[CUSTOMER][NEUTRAL] Uh yeah.
[CUSTOMER][NEGATIVE] Got it because I, I, I, I'm going through stuff right now and I don't know what they're gonna end up doing um.
[CUSTOMER][NEUTRAL] So I was trying to
[CUSTOMER][NEUTRAL] Figure out what was covered uh before I signed up. I'm a new hire too so.
[AGENT][NEUTRAL] I know, I understand.
[CUSTOMER][NEUTRAL] Yeah, OK, um, is.
[CUSTOMER][NEUTRAL] Are fibroid removals considered?
[CUSTOMER][NEUTRAL] Part of the outpatient?
[AGENT][NEUTRAL] Um, outpatient is considered if it's done in an outpatient facility like an outpatient surgery center, inpatients is.
[AGENT][NEUTRAL] You're confined in uh in hospital 18 hours or more. So if services are performed in a cover outpatient facility, which is usually ER, urgent care, ambulatory surgery center, MRI or imaging center, it could be covered under the policy.
[CUSTOMER][POSITIVE] Got it. OK, yeah, I don't know what they do for all of that, but I'll, I'll figure that out and I'll either enroll or not enroll, but thank you so much for your, your guidance.
[AGENT][POSITIVE] Uh, yes, ma'am. And uh thank you for calling APL. You have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye.