AccountId: 011433970860
ContactId: 143d5201-1ca8-446e-bdaf-8f83b6047483
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 216360 ms
Total Talk Time (AGENT): 95553 ms
Total Talk Time (CUSTOMER): 107897 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/08/143d5201-1ca8-446e-bdaf-8f83b6047483_20250508T20:42_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, hi, I just was trying to get some information, um, uh, let me give you my number, uh, the policy number, I guess, or what do you need from me?
[AGENT][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] OK, policy number 02312747.
[AGENT][POSITIVE] Thank you. May I have your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] for security, may I have your date of birth and mailing address on file?
[CUSTOMER][NEUTRAL] Sure, [PII] and the mailing address is [PII].
[AGENT][NEUTRAL] OK, may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm
[AGENT][POSITIVE] Thank you. And how may I assist you today, Miss?
[CUSTOMER][NEUTRAL] Yes, um, the reason for my call is I've had a couple of procedures done, um, and they're coding it as, like, for example, uh, I had a steroid injection at an orthopedics office, and so it's coded as like a, a surgical procedure even though it's an injection.
[CUSTOMER][NEUTRAL] Um, so I just didn't know, is that something that you all cover, uh, that's covered on my policy, because my primary, um, covered a portion of it, but it's still quite expensive, so I just didn't know since it's considered a surgical procedure.
[CUSTOMER][NEUTRAL] If that goes under like the window with that policy.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] What is the place of service, do you know, Miss [PII]?
[CUSTOMER][NEUTRAL] Um, they'll sell an orthopedics.
[AGENT][NEUTRAL] So it's gonna be a specialist.
[CUSTOMER][POSITIVE] Yes, it's a specialist exactly.
[AGENT][NEUTRAL] Mm. OK. So, um, in that case, um, I'm looking at your benefits and you don't have any office treatment benefits and so it's not gonna be covered because that's considered an office treatment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If it was a surgery center like outpatient surgery center or hospital, yeah, it would have been under the outpatient benefit since it's an office treatment specialist, it will not cover. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, and then.
[CUSTOMER][NEUTRAL] OK. All right then, thank you for that. Um, if I had like a biopsy, um, done, that one I'm gonna have to call them and see. Let me ask them. So if it's at a hospital or surgical center, then it's different, correct?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Correct. If it's an outpatient facility, not office, then we do cover outpatient facilities, hospital or um surgical centers or diagnostic centers. Those are covered. You also have benefits for independent lab. So those are the places that you can go and use this benefit. But if it's considered an office, a specialist or PCP then those are not covered, OK?
[CUSTOMER][NEUTRAL] And how about like an MRI that's done at a hospital?
[AGENT][NEUTRAL] Yes, it's a diagnostic testing done in a hospital that's considered outpatient, which is part of your outpatient maximum which is 1000 per calendar year.
[CUSTOMER][NEUTRAL] So that would be covered, that would be part of.
[AGENT][NEUTRAL] Yeah, we cannot guarantee any payments over the phone, but yeah, it will be something that it will be considered under the policy for outpatient.
[CUSTOMER][NEUTRAL] OK, so that one.
[CUSTOMER][NEUTRAL] Of course. No, no, no, I'm just trying to understand so I'm just trying to understand. OK, thank you. Bye-bye.
[AGENT][POSITIVE] You're welcome