AccountId: 011433970860
ContactId: 0efcae31-dcac-4269-8c25-c3994148f786
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 298260 ms
Total Talk Time (AGENT): 110997 ms
Total Talk Time (CUSTOMER): 136877 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/0efcae31-dcac-4269-8c25-c3994148f786_20250113T13:09_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, how are you? Good morning. Uh, I'm calling because, um, I have the University of Miami because I have an MRI appointment. It was supposed to be at [PII], but what happened is, um, they didn't, that they had to every year call again for the benefits, so they need the benefits because I have a co-payment with my insurance.
[AGENT][POSITIVE] Good morning.
[CUSTOMER][NEUTRAL] And they're, um, I don't know, they told me they, they call, they call you, but they say that for them, they have to wait for [PII]
[CUSTOMER][NEUTRAL] I don't know. Is that the, the, when the department open for?
[AGENT][POSITIVE] Well, we're actually open now for them to call and verify benefits. They can call us now.
[CUSTOMER][NEUTRAL] Yeah, she told me that they actually open to to so you guys can call them.
[CUSTOMER][NEUTRAL] Oh, no, [PII], yeah, is there a way that you can send me the my benefits, um, by email or by fax?
[AGENT][NEUTRAL] Um, no, ma'am, because of the, because of the HIPAA.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Um, what, yeah, because of the HIPAA, we can't email the benefits or um fax them directly to you. I apologize.
[CUSTOMER][NEUTRAL] OK, OK, so it has to be directly with them in a call.
[AGENT][NEUTRAL] Yes, ma'am. We will have to be directly with them.
[AGENT][NEUTRAL] I could speak with one of them now to verify benefits.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh OK, she told me that she kind of stay with one of the guys, yeah, then what I speak or no.
[CUSTOMER][NEUTRAL] Hi, good morning. My name is [PII]. I'm calling, um, this is from the University of Miami.
[AGENT][POSITIVE] OK. Yes, [PII] I can assist you with the benefits. Um, first, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. And could I get the policy number, please?
[CUSTOMER][NEUTRAL] Yeah, give me one second, let me open up her chart again.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm let's see here.
[CUSTOMER][NEUTRAL] OK, so the
[CUSTOMER][NEUTRAL] Is it, no, this is the group number. The inhospital benefit certain number or the outpatient because we're an outpatient facility.
[AGENT][NEUTRAL] The outpatient number.
[CUSTOMER][NEUTRAL] OK, 1252269 M as in Mary, L as in Mary, 8, the number 8.
[AGENT][NEUTRAL] OK. Thank you. Now, please verify her name and date of birth.
[CUSTOMER][NEUTRAL] [PII]. Her date of birth is a second, it's [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII] and just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on her policy was [PII].
[AGENT][NEUTRAL] And the policy is still active and for outpatient benefits, we cover up to $7150 per calendar year um for the co-pay, the co-insurance, and the deductible after the primary insurance processes the claim, but there is a $250 deductible that needs to be met first.
[CUSTOMER][NEUTRAL] OK, so $250 deductible. Is there any way you can send it to me through fax?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEGATIVE] Um, no, we're unable to send the breakdown of benefits to fax.
[CUSTOMER][NEUTRAL] OK, so you said effective [PII] currently active?
[CUSTOMER][NEUTRAL] Covers up to 7550.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] $7150 per calendar year, but there is a $250 deductible that needs to be met first.
[CUSTOMER][NEUTRAL] OK, um, and then you said that's for outpatient, right?
[AGENT][NEUTRAL] Yes, ma'am. Those are for the outpatient benefits.
[CUSTOMER][NEUTRAL] OK, can I have a reference number to this call, please?
[AGENT][NEUTRAL] Yes, for the reference number, you can use my name and today's date. My name is [PII] um it's spelled [PII] My last initial is [PII] and today's date. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] No, that'll be all.
[AGENT][POSITIVE] OK, well, I thank you again, [PII], for calling APL. You guys have a great day. Mm bye.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, alright, thank you so much. I appreciate it.
[AGENT][POSITIVE] OK. You're welcome. You're welcome. No problem. Have a great day. Mm bye.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] You too, bye.