AccountId: 011433970860
ContactId: 10b3dde1-efcf-49bf-b54a-56468ce3dee4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 500260 ms
Total Talk Time (AGENT): 126737 ms
Total Talk Time (CUSTOMER): 190707 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/10b3dde1-efcf-49bf-b54a-56468ce3dee4_20250514T12:35_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. This is Easy. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi [PII]. My name is [PII]. I'm calling from South Georgia Pediatrics. Needing to check the [PII] benefits on our insured.
[AGENT][POSITIVE] Um, yes, ma'am. I can assist you with benefits. Um, first, could I get your name again and a good callback number?
[CUSTOMER][NEUTRAL] It's [PII] The number is 912.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, [PII]. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] It is 024.
[CUSTOMER][NEUTRAL] 69142
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] It is uh [PII] and [PII] Date of birth is [PII].
[AGENT][NEUTRAL] Thank you and just let me advise you that verification of coverage does not guarantee payment of claims. Um, I'm showing the effective date on this policy was [PII] and the policy is still active. And is this for inpatient or outpatient benefits or an office visit?
[CUSTOMER][NEUTRAL] Yes it's for an office, is it?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I just need to see.
[AGENT][NEUTRAL] And one moment, the benefits are coming up.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK. Thanks for your patience. Um, for office visits, we cover up to $75 per visit and she gets 6 visits per calendar year.
[CUSTOMER][NEUTRAL] OK, that's for 6 office visits $75 and that's only for 6 visits.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You know, what about the wellness and immunizations?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, for routine health screenings, um, there's 3 different tiers. Um, there's the first tier is $75 per visit and she gets one per calendar year. And then the second tier is for $50. She gets one per calendar year. And then tier 3, it's um $100 and she gets one of those per calendar year and that's for routine health screenings.
[CUSTOMER][NEUTRAL] OK, which tier is her policy under I mean?
[AGENT][NEUTRAL] Um, she has 3. She has all 3 tiers and she gets 1 per calendar year. Yes, ma'am.
[CUSTOMER][NEUTRAL] All 3.
[AGENT][NEUTRAL] And one visit per calendar year.
[CUSTOMER][NEUTRAL] OK, so this.
[CUSTOMER][POSITIVE] Alright, so $100 this is tier one that's 23 and that's perfect, OK.
[CUSTOMER][NEUTRAL] That's one a year.
[CUSTOMER][NEUTRAL] Alright, and do we need to obtain a referral if we send her out to a specialist?
[CUSTOMER][NEUTRAL] Oh, and under the wellness prevented. I shots covered under this? Oh, this little girl.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] It's not coming for a health check yet, but we need to know.
[CUSTOMER][NEUTRAL] Oh, she's [PII] old.
[CUSTOMER][NEUTRAL] So is her immunizations when she gets [PII], if she still got this policy, we don't need to know.
[AGENT][NEUTRAL] Yes, ma'am, and that'll be included in the um routine health screening benefit.
[CUSTOMER][NEUTRAL] Oh, under the, under this included, OK, OK, now do we need to refer, I mean, um, obtain a referral from y'all since we're the PCP to send her to a specialist? Do we need to call and get a referral to do that?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And she just
[AGENT][NEUTRAL] Um, no, ma'am. There's no authorization required.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] OK, no problem.
[CUSTOMER][NEUTRAL] And can you tell me what layout it is that they use?
[CUSTOMER][NEUTRAL] Um, for out of office lab work. Is it lab core quest or?
[AGENT][NEUTRAL] Um, we work with all labs.
[CUSTOMER][NEUTRAL] OK, so either either level word.
[CUSTOMER][NEUTRAL] OK, request, OK, so we can, we just like to send them to the correct one that the insurance covers. That's why I asked, um.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Now do you know if it covers flu tests and scrap tests and COVID test?
[CUSTOMER][NEUTRAL] Her policy.
[CUSTOMER][NEUTRAL] For uh for office, I mean.
[CUSTOMER][NEUTRAL] And we, we do those at all.
[AGENT][NEUTRAL] Yes, it'll be included in the um office visit. Like I said, we cover up to $75 per visit. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so they will be covered if we did it under under the office visit. OK, this is yes for that.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, and I think that's all I need to know who's going.
[AGENT][NEUTRAL] OK. Are you sure, is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, hold on, OK, OK, y'all pay on this OK, I'm sorry, yes, for the sick visit off it, y'all pay $75 per visit, right? But does she need to pay a co-pay or anything?
[AGENT][NEUTRAL] Um, no, I'm not showing a copay on this policy.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] So it's all OK.
[CUSTOMER][NEUTRAL] Alright, so if anything other than the 75 covered for that it's, I mean, patient's responsibility or parents' responsibility.
[AGENT][POSITIVE] Yes, ma'am. That's correct.
[CUSTOMER][NEUTRAL] OK, OK, alright, thank you very much. um, can I get a reference number for the call?
[AGENT][NEUTRAL] Yes, for the reference number, you can use my name and today's date. Um my name is [PII]. It's spelled [PII] My last initial is [PII] and today's date. Um, is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No ma'am, that's all I needed thank you very much and you have a wonderful day.
[AGENT][NEUTRAL] You do the same, [PII]. Thank you for calling APO. Mm bye.
[CUSTOMER][NEUTRAL] Alright bye bye.