AccountId: 011433970860
ContactId: 14c6df9e-1028-4732-8f5b-b90558ef3849
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 232970 ms
Total Talk Time (AGENT): 113948 ms
Total Talk Time (CUSTOMER): 82828 ms
Interruptions: 0
Overall Sentiment: AGENT=2.1, CUSTOMER=2.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/14c6df9e-1028-4732-8f5b-b90558ef3849_20250303T21:20_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hi ma'am. My name is [PII]. I'm calling from Texas Digestive Specialist to verify um benefits and eligibility for a patient.
[AGENT][POSITIVE] OK, well, I can definitely help you with both the eligibility and the benefits. And you said your name is [PII]?
[CUSTOMER][NEUTRAL] Yeah, and what was yours? I'm sorry?
[AGENT][NEUTRAL] All right. My name is [PII] The [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome. And [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yes, phone number is [PII] and I am at extension [PII].
[AGENT][POSITIVE] Thank you for that.
[CUSTOMER][NEUTRAL] And um yes, the um policy number it would be 018687778.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, this is for [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And how many, well, you said eligibility and benefits, right?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Alright, so the policy has been active since [PII]. And what type of benefits did you want to go over today?
[CUSTOMER][NEUTRAL] Um, well, I, I'm familiar with this, um, insurance, and from what I've, um, aware it it only covers for procedures, right? It's, uh, doesn't cover for office visits.
[AGENT][NEUTRAL] Oh no, that's not true. So for the inpatient, yes, it's just inpatient um procedures and expenses after admission. For um outpatient, there's the emergency room, um, there's the office treatment rider. Let me, um, hold on one second, let me pull up the whole document.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But yes, with the office treatment rider, there's no in-office, like if you charge for a facility charge, place of service, there would be no coverage for that, but there is the office treatment rider in which the treatment in the office could be covered up to that 25, 50 a year.
[CUSTOMER][NEUTRAL] Oh OK, OK, but like for an office visit itself, um, you guys don't like the plan won't pay for that.
[AGENT][NEUTRAL] The actual charge of it.
[AGENT][NEUTRAL] Right, the actual like 99213 or something, yes, it wouldn't cover that code, but for the treatment in the office, the rider would come into play.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then you said that it was 2550, the limit for those.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, and do you see if she's accumulated any right now?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Oh, that's that was a calculator. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So she's used $6.63. Um, she has $2,543.37 left for the year.
[CUSTOMER][POSITIVE] Alrighty awesome thank you so much for that and uh if I could just have a reference number please.
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Thank you so much have a nice day.
[AGENT][POSITIVE] You're welcome, [PII]. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that was it thank you.
[AGENT][POSITIVE] Alright, thanks for calling APL. Have a great day.
[CUSTOMER][POSITIVE] You too thank you bye bye.
[AGENT][POSITIVE] Thank you, bye bye.