AccountId: 011433970860
ContactId: be2c4d42-ce2b-44af-a301-4678b0a0f152
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 244580 ms
Total Talk Time (AGENT): 132701 ms
Total Talk Time (CUSTOMER): 111548 ms
Interruptions: 6
Overall Sentiment: AGENT=0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/08/be2c4d42-ce2b-44af-a301-4678b0a0f152_20250508T19:15_UTC.wav
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[AGENT][NEUTRAL] Ha.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I'm sorry, I didn't understand a word you said.
[AGENT][NEUTRAL] OK. Are you able to hear me now?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, well, thank you for contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I'm calling because I need to do a procedure at a dermatologist and I wanted to know if I give you the CPT codes if you guys are able to cover anything towards it.
[AGENT][NEUTRAL] Yes, I could. I would be glad to look up your policy, and I'm sorry, with whom am I speaking, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And what is your policy number, please, [PII], so that I can look it up?
[CUSTOMER][NEUTRAL] Give me 1 2nd.
[CUSTOMER][NEUTRAL] Policy number 02579259.
[AGENT][NEUTRAL] Thank you. If I could verify your uh date of birth and a phone number, I'd appreciate it while I'm looking this up.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh, phone number is [PII].
[AGENT][NEUTRAL] Thank you. Now, it looks like your um policy when its back on [PII].
[CUSTOMER][POSITIVE] Good afternoon. Happy Thursday.
[AGENT][NEUTRAL] And it's active. So let's see what we have here for treatment within the physician's office.
[CUSTOMER][NEUTRAL] It's for, do you need the
[AGENT][NEUTRAL] That's considered outpatient hospital.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm sorry, do you need the CPT code?
[AGENT][POSITIVE] Uh, yes, you can certainly give that that to me, and what is that please?
[CUSTOMER][NEUTRAL] Give me 1 2nd.
[CUSTOMER][NEUTRAL] The CPT codes are 11406 and 13101.
[CUSTOMER][NEUTRAL] She
[AGENT][NEUTRAL] So this constitutes uh treatment within a physician's office, and your policy will pick up the deductible.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Co-payment or co-insurance from your major medical.
[CUSTOMER][NEUTRAL] To confirm your appointment at [PII] in the office.
[AGENT][NEUTRAL] Up to $1500 per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So what will happen is you will, um, when you go into the physician's office for treatment, I would just give them both cards. Give them your major medical card and this card as well, and what they will do is that they will file for your major medical first, and then we will pick up that deductible, co-payment or co-insurance um for the uh treatment within the physician's office.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, to give you, OK, so to give you an example, I went in yesterday and they told me that out of pocket would be $879.36. That's covered by you guys.
[AGENT][NEUTRAL] Yes, for some, as long as it's not cosmetic. Now, treatment for um for a uh sickness or, or disease uh or accident that is covered in.
[CUSTOMER][POSITIVE] I'm gonna call you later.
[CUSTOMER][NEUTRAL] There was.
[CUSTOMER][NEGATIVE] No, no, no, it's not, it's, it's not cosmetic, it's the CPT codes that I sent. It's an abscess that I have that grew.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, I see that. That's that that's what, um, uh, I, I see that and I see that where there's actually, uh, there's a repair that's with the tool.
[CUSTOMER][NEUTRAL] He
[CUSTOMER][NEUTRAL] So I shouldn't have a problem at the when rendering services, right?
[AGENT][NEUTRAL] No, there should not be a problem. Now, if, uh, if they want you to file the claim yourself, we will show you how to do that, uh, but this is what your policy is for is to pick up that deductible, co-payment, or co-insurance and treatment within the physician's office is covered. So I, as I mentioned before, I would, I would simply give them both cards.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And um let them know that uh that you do have the secondary insurance and they, they will file your primary insurance first and then uh through us.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, sounds good. Thank you so much for your help.
[AGENT][NEUTRAL] OK, there's nothing else I can help with, thanks for contacting ATL.