AccountId: 011433970860
ContactId: 185c78e4-b57e-4e89-8fa5-6ec9ac3321ad
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 224199 ms
Total Talk Time (AGENT): 124960 ms
Total Talk Time (CUSTOMER): 57841 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/185c78e4-b57e-4e89-8fa5-6ec9ac3321ad_20250421T13:47_UTC.wav
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[AGENT][POSITIVE] And thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, how are you? I'm calling from um a medical office. I just wanted to know the patients, um, maternity benefits.
[AGENT][POSITIVE] Um, yes, ma'am. I can assist you with benefits. Um, first, can I get your name and a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, [PII] [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII]. Now, I need the policy number, please.
[CUSTOMER][NEUTRAL] Yes, uh.
[CUSTOMER][NEUTRAL] It is 02216473 ML 8.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] And just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII]. The policy is still active.
[AGENT][NEUTRAL] And let's see.
[AGENT][NEUTRAL] Is this for services that will be provided in the office?
[CUSTOMER][NEUTRAL] Yeah, and the professional fee for delivering at the hospital.
[AGENT][NEUTRAL] OK. For inpatient benefits, um, for every admission, we cover up to $1000 per calendar year, and that's for the co-pay, the co-insurance, and the deductible after the primary insurance processes the claim. And for the office visits, we cover up to $200 per day and that's also for the co-insurance and the deductible after the primary insurance processes the claim, but the co-pay for office visits is not covered.
[CUSTOMER][NEUTRAL] OK, so $1000.
[CUSTOMER][NEUTRAL] Um, for the for the coinsurance, you said?
[AGENT][NEUTRAL] Yes, for the co-pay, co-insurance and deductible, um, after the primary insurance processes the claim, and that's for inpatient services. That's when she's admitted.
[CUSTOMER][NEUTRAL] Once she's admitted, OK.
[AGENT][NEUTRAL] Right. Mhm.
[CUSTOMER][NEUTRAL] So hospital.
[CUSTOMER][NEUTRAL] OK, but as far as um like in office, you guys don't cover that, it would just be hospital benefits?
[AGENT][NEUTRAL] Um, we cover, um, in-office also for in-office services, we cover up to, so, let me get back to that screen.
[AGENT][NEUTRAL] For in-office services, we cover up to $200 per day and that's for the co-insurance and the deductible after the primary insurance processes the claim, but the co-pay for the office visit is not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] $200 per day.
[CUSTOMER][NEUTRAL] For the co-pay you said, but then you said it's not covered?
[AGENT][NEUTRAL] For the co-insurance and the deductible for office visits, we cover up to 2 right, not co-pay.
[CUSTOMER][NEUTRAL] Not coping.
[CUSTOMER][NEUTRAL] OK, perfect. OK, may I have your name and a reference number please?
[AGENT][NEUTRAL] Yes, for the reference number, you can use my name and today's date. 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][POSITIVE] No, that was all thank you so much.
[AGENT][POSITIVE] OK. Thank you, [PII] for calling APL. Have a great rest of your day. Bye.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thanks.