AccountId: 011433970860
ContactId: 05a00ef3-c59c-4b0b-a724-ded6bb1fb67e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 412690 ms
Total Talk Time (AGENT): 167131 ms
Total Talk Time (CUSTOMER): 149322 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/05a00ef3-c59c-4b0b-a724-ded6bb1fb67e_20250609T20:07_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, good afternoon. This is [PII]. I'm calling from Doctor [PII]'s office.
[AGENT][POSITIVE] Yes, ma'am. And how can I help you? Yes, I'm still here.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Yes, um, I just need your, I, I just need your help because we have a patient, um, that has the supplemental card sent over to us so we want to understand more about the benefits of this card. I have the the details.
[AGENT][NEUTRAL] I'm sure, [PII], I can assist you with benefits. Um, first, could I get a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. Thank you. And now I need the policy number.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] On a second, where's the policy number?
[AGENT][NEUTRAL] It would be the outpatient certificate number.
[CUSTOMER][NEUTRAL] Yes, hold on, let me flip because the image is like vertical, so um I need to like
[CUSTOMER][NEUTRAL] Flip it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so,
[CUSTOMER][NEUTRAL] I have the hospital in in-hospital benefits cert number and outpatient. So which one do you need?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The outpatient.
[CUSTOMER][NEUTRAL] Outpatient 0248.
[CUSTOMER][NEUTRAL] 66
[CUSTOMER][NEUTRAL] 26
[CUSTOMER][NEUTRAL] M for Mike. L for Lima, number 8.
[AGENT][NEUTRAL] OK. Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Um, this is under the name, um, [PII]. This is the insured, um, name.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Hold on a second.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Last name is [PII], [PII].
[AGENT][POSITIVE] OK, thank you and her. Mhm.
[CUSTOMER][NEUTRAL] Date of birth [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII] and the policy is still active. And would this be for inpatient services, outpatient, or for an office visit?
[CUSTOMER][NEUTRAL] Um, there's
[CUSTOMER][NEUTRAL] Hold on a second, let me just write it down, so I don't miss it.
[CUSTOMER][NEUTRAL] But this is active.
[AGENT][NEUTRAL] Yes, ma'am. The policy is active. Mhm.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] OK, so what was the question?
[AGENT][NEUTRAL] Um, would this be for inpatient services, outpatient services, or is it for services provided in office?
[CUSTOMER][NEUTRAL] Um, outpatient and services provided in office.
[AGENT][NEUTRAL] OK, for outpatient services, including services provided in office, we cover up to 4000 per calendar year and that's for the co-pay, the co-insurance, and the deductible after the primary insurance process.
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah, um, is it OK if I record it so um I can review later on my recording?
[AGENT][NEUTRAL] Yes, ma'am. That's fine.
[CUSTOMER][NEUTRAL] Is that OK? OK, thank you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Ola, it's such estacciendo traduciaupulladen.
[CUSTOMER][NEUTRAL] This call is being recorded. OK, so the outpatient is up to $4000 per year.
[AGENT][NEUTRAL] Yes, ma'am. 4000.
[CUSTOMER][NEUTRAL] Uh for calendar year.
[AGENT][NEUTRAL] Yes, per calendar year, and it's for the co-pay, the co-insurance, and the deductible after the primary insurance processes the claim. Um, but for office visits, the copay is not covered. For office visits, we only cover the coinsurance and the deductible up to $4000 per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, all right.
[CUSTOMER][NEUTRAL] So any other benefits of this plan?
[AGENT][NEUTRAL] Um, yes, their services, um, let's see, provided for lab and DME that's also covered up to 4000 per calendar year, um, for co-pay, co-insurance, and the deductible. And then there's also benefits for inpatient hospital. If a, um, patient is um admitted, we cover also up to 4000 per calendar year for co-pay, co-insurance and deductible.
[CUSTOMER][NEUTRAL] OK. So what about um procedures in the outpatient in the hospital? Like CT scans and stuff?
[AGENT][NEUTRAL] Yes, ma'am. That's covered up to 4000 per calendar year under the outpatient benefit. And that's um if it takes place in the hospital, um, the co-pay, the co-insurance and deductible is covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. All right.
[CUSTOMER][NEUTRAL] OK. Um, and, uh, that's about it. I'm just gonna take note of this.
[CUSTOMER][NEUTRAL] OK, when is the expiration? Does it, does it have an expiration?
[AGENT][NEUTRAL] Um, no, I'm showing that the policy is active. There's no, um, expiration date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, all right. OK, thank you so much. I appreciate it.
[AGENT][NEUTRAL] Is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] Um, yeah. What about for office visits?
[CUSTOMER][NEUTRAL] You also cover that?
[AGENT][NEUTRAL] Um, the co-pay for the office visit is not covered after the primary insurance processes the claim, but we do cover the charges that go towards the co-insurance and the deductible for services provided in office, and that's covered up to $4000 per calendar year.
[CUSTOMER][POSITIVE] OK. All right. OK. All right, thank you so much. I appreciate it.
[AGENT][POSITIVE] OK. I thank you again, [PII], for calling ATL. You have a great rest of your day. Mm bye.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] This call is no longer being recorded.