AccountId: 011433970860
ContactId: 06a88f76-47f7-42ec-9109-de5c51e1657b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 291170 ms
Total Talk Time (AGENT): 110802 ms
Total Talk Time (CUSTOMER): 57748 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/06a88f76-47f7-42ec-9109-de5c51e1657b_20250527T18:48_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling to confirm, I guess, uh, that a patient is active and uh got plan benefits.
[AGENT][POSITIVE] So I can help you with eligibility and benefits [PII]. Can I get a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, it's gonna be a direct line of [PII].
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] I have 02267963 ML 8.
[AGENT][NEUTRAL] OK, 22679 and what was the rest?
[CUSTOMER][NEUTRAL] 63.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just a moment.
[AGENT][NEUTRAL] And can you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] OK, I'm showing this policy is active with an effective date of [PII].
[AGENT][NEUTRAL] This is a Medlink policy, so it's secondary gap insurance.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And when you're filing a claim for this policy, you will need to submit the primary EOB or explanation of benefits as well to show that benefits were paid. If if there, uh, major medical doesn't pay for benefits, this policy will deny it. This policy helps with co-pay, co-insurance, and co-deductible.
[CUSTOMER][NEUTRAL] Perfect. OK. So for this patient, it would be a co-payment um for radiology outpatient. What would be the coverage?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me check on it.
[AGENT][NEUTRAL] I'm gonna pull up their policy, so just give me a moment.
[AGENT][NEUTRAL] And you said radiology?
[CUSTOMER][POSITIVE] Yeah. Correct.
[AGENT][NEUTRAL] OK, just wanted to make sure.
[AGENT][NEUTRAL] OK, let me see.
[AGENT][NEUTRAL] I'm not showing anything specifically for radiology, but I do have some outpatient benefits. Now this is just a verification of benefits and not a guarantee of payment.
[AGENT][NEUTRAL] They do have an outpatient benefit maximum of up to $1500 per covered person per calendar year.
[CUSTOMER][NEUTRAL] I'm sorry, what was the coverage? How much per year?
[AGENT][NEUTRAL] 1500.
[AGENT][NEUTRAL] With a $0 deductible per calendar year.
[CUSTOMER][NEUTRAL] 1500.
[CUSTOMER][NEUTRAL] Alright, per year, are you able to see if they, if he uses any?
[AGENT][NEUTRAL] I see.
[AGENT][NEUTRAL] It's only used about $15 so he should be covered for the most part.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] Mhm. And that's just for this year?
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Alright, sounds great. OK, in that case then, can I please have a reference number for the call?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We don't have reference numbers, but you can use my name and last initial in today's date. So [PII], and today's date.
[CUSTOMER][POSITIVE] Got it, [PII] Thank you so much for your help and have a great rest of your day.
[AGENT][POSITIVE] Thank you for calling ATL. Have a great day.
[CUSTOMER][POSITIVE] Thank you, bye bye.