AccountId: 011433970860
ContactId: 0ea863c3-365b-48c6-88cd-88433f3372eb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 264829 ms
Total Talk Time (AGENT): 105945 ms
Total Talk Time (CUSTOMER): 120688 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/0ea863c3-365b-48c6-88cd-88433f3372eb_20250213T19:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], uh, my name is [PII] and I work for Lake City Surgery Center here in [PII] and, yeah, in [PII]. Uh, I need to call for um.
[CUSTOMER][NEUTRAL] Benefits and eligibility on a patient.
[AGENT][NEUTRAL] OK, I'm happy to check on eligibility and benefits, [PII]. What is the patient's policy number?
[CUSTOMER][NEUTRAL] It is let me get that up. I knew there was something I was missing. Oh, it's 02448913 M M like Mary L like Larry 8.
[AGENT][POSITIVE] All right, thank you so much. Let me take a look here.
[AGENT][NEUTRAL] And if I could get the patient name and date of birth?
[CUSTOMER][NEUTRAL] Her name is [PII] Her date of birth is [PII].
[AGENT][POSITIVE] Alright, thank you so much, [PII]. So patient plan is active. The effective date is [PII]. We are the secondary insurance, so this is gonna cover deductible, co-pay and co-insurance.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, um,
[CUSTOMER][NEUTRAL] If I give you some CPT codes, can you tell me if it's they're gonna be covered?
[AGENT][NEUTRAL] We generally don't check, yeah, we generally don't check codes. Is it for like an office visit, outpatient?
[CUSTOMER][NEUTRAL] The co-pays?
[CUSTOMER][NEUTRAL] It's outpatient. It's gonna be a um surgery, an outpatient surgery.
[AGENT][NEUTRAL] Let's see here.
[CUSTOMER][NEUTRAL] That's the left wrist.
[CUSTOMER][NEUTRAL] I can't read the doctor's writing, um.
[AGENT][NEUTRAL] Let me, let me see here what is.
[CUSTOMER][NEUTRAL] It looks, it looks like gas light, but I don't think that's what it is. If there's a cyst on her left wrist and a forearm.
[AGENT][NEUTRAL] OK, let me
[AGENT][NEUTRAL] Most of the time these plans will cover um things of that nature. Really the most, the most common thing I see is it just not covering like an office visit fee.
[AGENT][NEUTRAL] Um, let me see.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] It's gonna be outpatient. Those are all inpatient.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, yeah. So it looks like it will fall under outpatient covered charges and the definitions.
[CUSTOMER][NEUTRAL] OK, it'll cover what Blue Cross Blue Shield like co-pays and co-insurance and stuff like that that doesn't pay, right?
[AGENT][NEUTRAL] Um, they
[AGENT][NEUTRAL] Correct, but the most it's gonna pay out on the calendar day this patient plan is a calendar day limit and it's $500 max.
[CUSTOMER][NEUTRAL] OK, so everything that's over 500 from what the other insurance doesn't pay, she's responsible for?
[AGENT][NEUTRAL] Right, because we're only gonna pay the 500, yeah, nothing additional.
[CUSTOMER][NEUTRAL] Is that what I'm hearing?
[CUSTOMER][NEUTRAL] OK, so I think it's like 1600 for her.
[CUSTOMER][NEUTRAL] Well right now it's for her outpatient fees from Blue Cross Blue Shield so you will pick up the 500 and then she's left with the 900 or so left.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Yeah, cause that's the outpatient max on it, yep.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah, OK, that's all I needed to know. Can I have a reference number for this call?
[AGENT][POSITIVE] All right, sounds good.
[AGENT][NEUTRAL] Absolutely, that's gonna be my name with my last initial in today's date. My name again is [PII], that's [PII] and [PII].
[CUSTOMER][NEUTRAL] OK, and today's date, right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] All right, thank you very much you've been very helpful you have a great day you too bye bye.
[AGENT][POSITIVE] You're welcome. Have a good day.
[AGENT][NEUTRAL] Bye bye.