AccountId: 011433970860
ContactId: 1ce66fae-6c7b-4567-8ff5-0c9b1e6ae234
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 241419 ms
Total Talk Time (AGENT): 118155 ms
Total Talk Time (CUSTOMER): 74416 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/16/1ce66fae-6c7b-4567-8ff5-0c9b1e6ae234_20250516T16:03_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, so I'm calling from MD Family Clinic. I'm calling because I have a patient wanting to know if she can be seen with her insurance here, and we have never seen this insurance, so we just wanted to see if we were in network with them.
[AGENT][NEUTRAL] Oh OK. Um, may I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] My name is [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And a good call back is the [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] The policy number is I did not get that. I am so sorry um I have her date of birth and last name and phone number.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] OK, let me have her last name and first name spelling.
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] First name is [PII]
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Apostrophe E.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And OK, what's the date of birth?
[CUSTOMER][NEUTRAL] The date of birth is [PII].
[AGENT][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] Really
[AGENT][NEUTRAL] OK. All right, I found the member. Um, let me pull this.
[AGENT][NEUTRAL] Benefit information. And before I give you benefit information, I need to let you know that this is not a guarantee of payment just for verification of coverage. And this particular policy is one of our limited hospital indemnity policies. Um, with this one, and they don't, they don't have a network. If the provider participates with multi-plan, they get that additional discount, but it is not required.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, we paid a flat amount based on the service rendered.
[AGENT][NEUTRAL] Um, for this one, let's see, for an office visit, and this is not a guarantee of payment, just a verification of coverage. The office visit is covered at $100 per visit, maximum of 4 visits per cover person per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And do you, do you need the provider's MPI number to see if we are in network or not?
[AGENT][NEUTRAL] We don't have any networks so we don't have a way of uh finding any networks.
[CUSTOMER][NEUTRAL] OK, so how, so you said that like you verify this how exactly like you, um, basically.
[AGENT][NEUTRAL] We just pay a flat amount, but no, there's no network. So we pay a flat amount no matter if you're in network with multiplan or not. Multiplan is just an additional discount they get if you participate with multiplan, but it is not required for them to or for you to send the claim for the member. So we pay $100 regardless as long as we receive the claim, and that is what we pay a flat amount of $100 up to 4 businesses per year.
[CUSTOMER][NEUTRAL] If the providers in network?
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, alrighty, I will go ahead and let the patient know.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else I may help you with today? Any other questions or concerns?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Oh sure.
[CUSTOMER][NEUTRAL] No, ma'am, that's it.
[AGENT][POSITIVE] OK, well, thank you for calling APL. You have a good day, [PII].
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye