AccountId: 011433970860
ContactId: a6468522-7cb1-4d3d-be86-5ef639447a90
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 302920 ms
Total Talk Time (AGENT): 155887 ms
Total Talk Time (CUSTOMER): 131759 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/a6468522-7cb1-4d3d-be86-5ef639447a90_20250620T13:57_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], I'm sorry I'm hearing you a little muffled just in case I don't know if you're hearing me well I just wanna make sure.
[AGENT][NEUTRAL] Well, yes, I'm having trouble with my phone. I do apologize and uh I'm sorry, uh, my name is [PII]. I'm with American Public Life. How can I help you?
[CUSTOMER][NEUTRAL] It's OK.
[CUSTOMER][NEUTRAL] I'm calling because I wanted to find out um.
[CUSTOMER][NEUTRAL] In reference to a procedure that was done to my husband and I wanna know if it's if if it would be even for me to send the secondary claim to um American Public Life.
[AGENT][NEUTRAL] Well, let's look at your policy, and I'm sorry, I didn't catch your name.
[CUSTOMER][NEUTRAL] Uh um [PII].
[AGENT][NEUTRAL] [PII], yes, thank you. What is your policy number, please, that I may look that up.
[CUSTOMER][NEUTRAL] Um, let me give it to you. Hold on, um, 02494313.
[AGENT][NEUTRAL] Thank you very much. And if I could just just for verification purposes, uh, I just need to know your date of birth and a phone number, please.
[CUSTOMER][NEUTRAL] The number here is [PII] um excuse me um the office is [PII].
[CUSTOMER][NEUTRAL] [PII] and my date of birth is [PII].
[AGENT][NEUTRAL] Thank you very much. Now what was, excuse me just a moment here. I'm just trying to get my screens together. Um, are you able to hear me a little bit better than us? I'm sorry, as I mentioned before, I'm having trouble.
[CUSTOMER][POSITIVE] No, I hear you perfect now. After I mentioned it you whatever you did worked, so we're good.
[AGENT][POSITIVE] Oh wonderful.
[AGENT][NEUTRAL] Oh yeah.
[AGENT][NEGATIVE] Well, I'm afraid I didn't want you to think I was screaming at you. Um, what is the C?
[CUSTOMER][NEGATIVE] No, no, not at all not at all.
[AGENT][NEUTRAL] Uh, what is that code that we're looking at to see if that's covered by your policy?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] My husband went to a specialist where they did a muscle test done.
[CUSTOMER][NEUTRAL] Um, I have the I guess the codes that the insurance that he built the insurance for. I just wanna know if it's something that I should send it to you guys and you guys will take a look at it. Um, it's, uh, the procedure number or.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] The procedure code is 959-10.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] There's 3 of them 958-86.
[CUSTOMER][NEUTRAL] And 958-885.
[AGENT][NEUTRAL] Now, um, I'm looking this up, uh, now, your policy is for accident or sickness. So if this is a wellness exam.
[AGENT][NEUTRAL] Um, then it wouldn't be covered. So what I'm gonna do is I'm gonna look these up. I'm gonna see how these are, are listed. So did he just do this, uh, just as a.
[CUSTOMER][POSITIVE] Yeah, because they were, it's, it's, I'm sorry to interrupt you, it's he went to an outpatient to get this procedure done.
[AGENT][NEUTRAL] Yeah, it's fine.
[CUSTOMER][NEUTRAL] That the doctor has, so that's, that's why I'm asking if it would be covered. This is not just like a medical exam that he, you know, or an office visit because the office visit is totally different. I have it here and I know it's an outpatient, so I know how the insurance works. That's why I wanted to touch base with you.
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] No, I see that.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Yes, absolutely, yes, I see that now. Uh, I'm sorry, um, so what we will do, yes, please send it in, um, you have, uh, up to $6000 for this type of service, OK, so what we'll do is we'll pick up your deductible, co-payment, or co-insurance for this outpatient service up to $6000. It doesn't look like your husband has used any of it, so he's got all these benefits available, um, so, uh, please send that in. Now when you're sending that in to us, uh, [PII], if you don't mind, please.
[AGENT][NEUTRAL] Um, sending in, uh, the, um.
[AGENT][NEUTRAL] The, the documents from, from this procedure. We also need a copy of your explanation of benefits and uh we need to have the, the diagnosis code from the provider just, just telling us what what was going on.
[CUSTOMER][NEUTRAL] I have it I have it because they already submitted the claim and I have the explanation of benefits, so I'll go ahead and submit that as well.
[AGENT][POSITIVE] That's wonderful. Is there anything else at all that I may help with?
[CUSTOMER][NEUTRAL] No, nothing whatsoever and um is I can do it by the mail and what's the other option on submitting it?
[AGENT][NEUTRAL] Well, the, the fastest way possible is to do it online. Um, you can, you can certainly uh mail that to us, but, um, you can go online to our online service center.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that is um [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Now when you do that, uh, we have updated our, uh, we've updated our uh system so you'll have to create an account, but once you create an account, yeah, it, it doesn't take long, and, and then we get it just within minutes and we process it within 6 to 10 business days. So, uh, if you don't mind doing that for us, please, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Great.
[AGENT][NEUTRAL] Is there anything else at all that I can help with?
[CUSTOMER][NEUTRAL] Not at all. I'll go right ahead. No, that's it.
[AGENT][POSITIVE] OK, well, thank you very much for contacting API.