AccountId: 011433970860
ContactId: 1488de3f-46c6-40bf-9d0a-3705b662fdc1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 179699 ms
Total Talk Time (AGENT): 110010 ms
Total Talk Time (CUSTOMER): 53524 ms
Interruptions: 2
Overall Sentiment: AGENT=1.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/1488de3f-46c6-40bf-9d0a-3705b662fdc1_20250507T21:36_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon, this is [PII]. I'm calling because I'm trying to get eligibility and benefits for a member.
[AGENT][POSITIVE] OK, yeah, I can check eligibility and benefits for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] 01868846
[AGENT][NEUTRAL] OK, and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that. So this policy is active. Effective date uh for this member was [PII], and this is a secondary medical policy, so it is designed to help with co-pay, deductible and co-insurance after major medical pays, and we're needing to look at inpatient or outpatient benefits, [PII].
[CUSTOMER][NEUTRAL] Outpatient
[AGENT][NEUTRAL] OK, and of course I will let you know verification of coverage is not a guarantee of payment for claims, so the outpatient benefit is $2550 per calendar year. If you'll give me one moment, I'll see if any of that has been used.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so [PII] has not used any of this benefits so far this year.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] And you, I'm so sorry, you said that was their, their deductible, right?
[AGENT][NEUTRAL] No, no, no, that's the uh total benefit amount payable for this policy. This policy does not have a deductible, no out of pocket, nothing like that.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yeah sorry that was a bit confusing. Yes, that's the total benefit amount allowable per calendar year.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] OK, so that's like how much I get it awesome and then do you know if um.
[AGENT][NEUTRAL] Right, so it's, it would pay the copay deductible and co-insurance until it reaches that maximum.
[CUSTOMER][NEUTRAL] And that amount.
[CUSTOMER][POSITIVE] Oh, OK, that's cool. I haven't seen one of these at all, um, yeah.
[AGENT][NEUTRAL] It is a bit different, yeah, it is.
[CUSTOMER][NEUTRAL] That's why it kind of threw me off. I was like, wait what, um, and then are do you know if authorizations are required for exams?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] No, it is not, um, so this policy is a very dependent on whoever they have as their primary insurance as long as their primary is willing to pay this policy can and just simply follows a major medical guidelines.
[CUSTOMER][NEUTRAL] Got it and then if I can get a reference number for our call.
[AGENT][NEUTRAL] Sure, that would just be my first name, last initial, and today's date and so my name is spelled [PII] Was there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] No, that was it
[AGENT][POSITIVE] Alright well thanks for giving us a call. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] Likewise bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.