AccountId: 011433970860
ContactId: 0ba13a81-af96-415e-9332-41bdbe5134c3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 316600 ms
Total Talk Time (AGENT): 174112 ms
Total Talk Time (CUSTOMER): 121838 ms
Interruptions: 4
Overall Sentiment: AGENT=1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/0ba13a81-af96-415e-9332-41bdbe5134c3_20250203T18:42_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm calling to see if you're able to provide me with uh benefits and eligibility for one of your members, please.
[AGENT][POSITIVE] Sure, I can assist you with that. Can I have your name and a callback number for you?
[CUSTOMER][NEUTRAL] My name is [PII]. Callback number is [PII].
[AGENT][NEUTRAL] Please, what is the policy number of the member that you're inquiring eligibility for today?
[CUSTOMER][NEUTRAL] 971-141
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], date of birth [PII].
[AGENT][NEUTRAL] And you're calling to verify benefits and eligibility?
[CUSTOMER][NEUTRAL] Uh, yes.
[AGENT][NEUTRAL] This member's policy has been active since [PII] and is currently active.
[AGENT][NEUTRAL] Ada has a maximum benefit amount of 5, I'm sorry, $4250 per calendar day.
[AGENT][NEUTRAL] For outpatient services and this is not a yes per calendar day and this is not a guaranteed benefits just a disclaimer of the policy's coverage. Someone just called here. [PII] just called here about the same policy and I expressed to her that it is per calendar day, not per calendar years per calendar day.
[CUSTOMER][NEUTRAL] Per calendar day?
[AGENT][NEUTRAL] But I'm, I think she was a little confused when she got off the phone, but [PII] literally just called her about it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't know who that is.
[AGENT][NEUTRAL] Oh OK. Well, she may be from somewhere else. Someone else just called for benefits and when I said per day, she said she had the same reaction as you did, and it's with per day. Are you sure it's per day?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yeah, because normally we, yeah, because normally, normally we hear like calendar year but I guess that.
[AGENT][POSITIVE] This is a good policy.
[CUSTOMER][NEUTRAL] OK, so it's for.
[AGENT][NEUTRAL] When I was giving it to.
[CUSTOMER][NEUTRAL] So it's $4250 OK, per day.
[AGENT][POSITIVE] Mhm. When I was just giving it to the prior caller, I was like to myself like, this is a good policy per calendar day.
[CUSTOMER][NEUTRAL] Yes, it is. I know.
[CUSTOMER][POSITIVE] I agree.
[AGENT][NEUTRAL] I could imagine how what her primary deductible and out of pocket is because for it to be that good, it has to be steep.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Oh, no, for sure, for sure, for sure.
[CUSTOMER][NEUTRAL] So this covers um.
[CUSTOMER][NEUTRAL] I mean outpatient and inpatient ambulatory service whatever it's not covered by primary um they take they they pick up up to 40 to 150.
[AGENT][NEUTRAL] Yes ma'am. So outpatient is different. He outpatient benefit is different. Give me one moment, let me finish my notes and I can give it to you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, because this is this is this is for um outpatient, but this is ambulatory surgery center. I don't know if you guys consider that to be outpatient.
[AGENT][NEUTRAL] And so that's out that'll be considered as outpatient.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Surgery center is outpatient, but if something, we're gonna pray nothing happens that goes the wrong way, but
[AGENT][NEUTRAL] Anything under 18 hours is considered as outpatient, but for inpatient, anything 18 hours and over.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Over 18 hours, that's considered as inpatient and her inpatient benefits is only $5500 per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For outpatient?
[AGENT][NEUTRAL] For inpatient.
[AGENT][NEUTRAL] That was for inpatient, the $5500 per calendar year, yes.
[CUSTOMER][NEUTRAL] Oh, inpatient.
[CUSTOMER][NEUTRAL] OK, so that's for inpatient. Mhm.
[AGENT][NEUTRAL] And then she has a, mhm, and she also has a treatment rider as well, which falls under her outpatient benefits. And when I say a treatment rider, meaning that if she has an office visit and she received treatment, the treatment will be covered but not the office visit itself.
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] So then the 40 to 50 per day, that's for outpatient.
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. So 4250 per day. Uh, no, um, can you spell your name and the initial to your last name for me, please, and a reference number if you have that.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII], and today's date is a reference, and the first initial of my last name is [PII].
[CUSTOMER][POSITIVE] All right, perfect.
[CUSTOMER][POSITIVE] Excellent thank you so much [PII]. I really do appreciate it.
[AGENT][POSITIVE] Is there anything else that I can assist you with? You're welcome, [PII]. Thanks for calling ATL.
[CUSTOMER][NEUTRAL] You said [PII] it's [PII] or [PII]?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, perfect, excellent thank you so much I do appreciate it and I hope you have a great rest of your day.
[AGENT][POSITIVE] Thank you [PII], and you do the same thanks for calling APL. Goodbye.
[CUSTOMER][POSITIVE] Thank you. Mm bye-bye.