AccountId: 011433970860
ContactId: 22d706e8-9c3b-4f8b-b291-586d0987f93b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 283369 ms
Total Talk Time (AGENT): 141941 ms
Total Talk Time (CUSTOMER): 119274 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=2.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/22d706e8-9c3b-4f8b-b291-586d0987f93b_20250415T15:26_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning, [PII]. Uh, my name is [PII] I'm calling from Centera RMH Medical Center. I'm trying to verify a patient's eligibility, please, and what type of insurance this is as well.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. I can help you, Ms. [PII]. Um,
[AGENT][POSITIVE] With the both the eligibility and the, the benefits. Um, can you please give me your, you're so welcome. Can you please give me your callback number, ma'am, just in case the call gets dropped, I'll be able to call you right back.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Oh definitely um it's [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] Um, patient's name is [PII]. Date of birth is [PII], and we have a policy number of.
[CUSTOMER][NEUTRAL] 02595680
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're very welcome. OK, I do show that Ms. [PII] does have an active policy. The effective date of her policy is [PII].
[AGENT][NEUTRAL] And this is just to verify her benefits. It's not a guarantee of payment. This is a supplemental insurance policy. It's billed secondary to the primary. It helps with deductible, co-pay and co-insurance.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So she has an inpatient benefit amount per calendar year of $3000 and then she also has an outpatient calendar year benefit amount of $3000 to go towards deductible co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK, and y'all just cover the deductibles and copay and copays slash coinsurances only, right?
[AGENT][NEUTRAL] Yes,
[AGENT][NEUTRAL] Correct, so the primary will need to be billed and when the claim is sent in the EOB from the primary needs to be sent so we can see what the primary paid.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so prior to the bills and the ELB.
[CUSTOMER][NEUTRAL] From primary to be sent to OK.
[CUSTOMER][NEUTRAL] And I'm assuming because you said that y'all just cover like the deductibles, copays and co-insurances, does that mean that y'all don't do like authorizations, especially if the member gives birth or anything?
[AGENT][NEUTRAL] No, we, um, it does require authorization because it's not the primary major medical insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And would we also put this plan like on the baby's account or just only the number?
[AGENT][POSITIVE] You can do it for the baby also.
[CUSTOMER][POSITIVE] OK, baby will be covered. Got you.
[AGENT][NEUTRAL] For the mother's part in giving birth for baby for newborn.
[CUSTOMER][NEUTRAL] OK. And I'm sorry, I got a lot of questions, one more 2 more questions actually.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] Um, sometimes they, our babies particularly, um, get sent to NICU, admitted to NICU, which I'll still cover if the baby gets gets admitted to NICU.
[AGENT][NEUTRAL] Right. It will be for newborn. Um, what mama will have to do is, um, when she's able to, she can add baby to the policy, and they'll retroactive the date to the date the baby was born.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's newborn to policy.
[CUSTOMER][NEUTRAL] You get to you. OK. And then the last thing would be, can I get the spelling of your name with the last initial and a call reference number if you have one.
[AGENT][NEUTRAL] Yes, yes, yes, ma'am. It's uh the call reference is my name, [PII] and today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Alright, thank you so much Miss [PII] I really appreciate it.
[AGENT][POSITIVE] You're very welcome. I hope I hope I was able to explain it to where you could understand it. It's, it's a different kind of policy, but it's very beneficial.
[CUSTOMER][POSITIVE] Oh, I can definitely tell I kind of [PII] jealous of the patient, and I'm sorry, I, I, I don't think I typed your last initial. Do you have one, Miss [PII], you're allowed to provide? OK. Thank you so much, Ms. [PII].
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] It's A
[AGENT][NEUTRAL] Yes, it's A
[AGENT][POSITIVE] You're very welcome. I hope you have a good rest of your week, Ms. [PII]. Thanks for calling APL.
[CUSTOMER][POSITIVE] You too. You take care.
[AGENT][NEUTRAL] You too. Bye-bye.
[CUSTOMER][POSITIVE] Thank you. Bye bye.