AccountId: 011433970860
ContactId: 31657e57-cd84-41f9-8e32-c00e1b524722
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 328459 ms
Total Talk Time (AGENT): 169468 ms
Total Talk Time (CUSTOMER): 138354 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/31657e57-cd84-41f9-8e32-c00e1b524722_20250409T19:57_UTC.wav
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[AGENT][NEUTRAL] For contacting ATL, my name is.
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I was wondering if you could help me with my policy.
[AGENT][NEUTRAL] I can certainly do that. Uh, [PII], what's your policy number, please?
[CUSTOMER][NEUTRAL] 02350220
[AGENT][NEUTRAL] Thank you. And if I could verify um your date of birth and a phone number, please?
[CUSTOMER][NEUTRAL] My date of birth is [PII].
[CUSTOMER][NEUTRAL] And my cell phone number is [PII].
[AGENT][NEUTRAL] Thank you very much. I have your policy pulled up. It looks like uh it was active as of [PII]. How can I help you with your policy?
[CUSTOMER][NEUTRAL] Um, I have some procedure codes. Um, I need to have surgery on my shoulder, and I'm just wondering if any of it would help, um, my APL, APL policy. I know it's secondary to my Blue Cross policy, um, but if anything would be picked up for the surgery, if I should have it in the hospital versus at their ambulatory care facility.
[AGENT][NEUTRAL] Well, it's actually gonna be the exact same thing. So what your policy will cover, uh, is in-hospital stays as well as outpatient hospital stays. So outpatient hospital that includes, um, of course, the regular hospital, uh, any stay under 18 hours.
[AGENT][NEUTRAL] Um, outpatient surgery centers, those are covered under your outpatient, uh, benefits, um, the ER, urgent care, that sort of thing. And so what we'll do for an outpatient surgery center.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, we will pick up the deductible, co-payment or co-insurance up to $3500. So really the, the main thing that you'd want to know, [PII], is, is whether you're in network with your major medical. There, there needs to be a deductible, co-payment or co-insurance for us to, you know, to really be beneficial to you, um, so that's the main thing that we would need to look at.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so, OK, sounds like I can, I cause I knew that the um the benefits were better if I was in the hospital or in, you know, having it done at the hospital like I've already had an MRI done and I had it done at the hospital.
[CUSTOMER][NEUTRAL] Because I didn't know if that was better than like it somewhere um else that you know does imaging like that.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Well, you know, any place that, uh, that bills is an outpatient, the, the only thing that isn't really covered is treatment, uh, or procedures within a physician's office. Um, and so if it's, if it's some sort of outpatient facility, uh, it, it very likely it's gonna be covered.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, do you know what you've paid so far year to date for me?
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] Uh, yes, let's just check here.
[AGENT][NEUTRAL] OK, so for the calendar year [PII].
[AGENT][NEUTRAL] Um, we have paid, uh, $1,683.53 so far. Now, um,
[CUSTOMER][POSITIVE] Oh wow, you've paid, you've paid a lot. Yeah.
[AGENT][NEUTRAL] Yeah, so that, that includes uh some uh uh a uh couple of facility, uh, hospital bills, um, on the [PII] and the [PII]. Um, those were the ones that, uh, those two things are the things that, uh, amounted to that 16 $1600.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I recently, um, a week ago, was it this Monday or no, it was a week ago Monday. I had an MRI done and I bet you that hasn't um made it to you guys.
[AGENT][NEUTRAL] It doesn't look like it. Um, sometimes it just takes a little bit of time for that to get to us, um.
[AGENT][NEUTRAL] It's, it just depends on how quickly they they send in the billing, but it doesn't look like we've received it yet.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Sounds good. So it sounds like I need to call Blue Cross next.
[CUSTOMER][NEUTRAL] Figure out where they're at with my out of pocket.
[AGENT][NEUTRAL] Sure. Oh, it.
[CUSTOMER][NEUTRAL] And see who's in that see what's in network for them just to make sure everything, yeah.
[AGENT][NEUTRAL] He's in network.
[AGENT][POSITIVE] Yes, yeah. Your Blue Cross advocate should be able to tell you that. So yes, just as long as you're in network with them, um, and there is a deductible co-payment or co-insurance, and it's not cosmetic surgery or anything like that, we're, we're good.
[CUSTOMER][POSITIVE] Yes, I'm very thankful my employer offers the APL though it's a nice benefits that we have, so.
[AGENT][NEUTRAL] Well, thank you. I, and you know, we, we want to make sure that you use that. So um if you do have any questions about uh about the claim or whether something's been turned in or not, please just let us know.
[CUSTOMER][POSITIVE] Sounds good thank you so much you have a good day.
[AGENT][POSITIVE] Mhm. Thanks for contacting AP. Have a good day.