AccountId: 011433970860
ContactId: 2acf135d-6c1e-4eb8-a6e1-905b48cefc36
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 851890 ms
Total Talk Time (AGENT): 451173 ms
Total Talk Time (CUSTOMER): 268891 ms
Interruptions: 6
Overall Sentiment: AGENT=0.5, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/18/2acf135d-6c1e-4eb8-a6e1-905b48cefc36_20250418T18:06_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 morning. I'm calling from a provider's office in regards to a patient. Um, can I give you their their name and date of birth?
[AGENT][NEUTRAL] Uh, sure, um, were we needing to check eligibility?
[CUSTOMER][NEUTRAL] Uh, yes, eligibility and benefits.
[AGENT][POSITIVE] Got it. OK, yes, I can check out the benefits for you. Uh, what was your name, please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK, and [PII], can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] Yes, phone number is [PII].
[AGENT][NEUTRAL] Thank you. And then did you have the policy number?
[CUSTOMER][NEUTRAL] Yes, I do. It is D as in David, 41203561.
[AGENT][NEUTRAL] OK, so that's not going to be one of our policy numbers, [PII]. That is through, uh, they're called 90 degree benefits. Um, if you call the number on the back of their card, uh, that might be how you got to us. I believe to get to 90 degrees it's, uh, option one.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] I did press option one do you have like a better number that I could call?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, I only have the one. It's possible that I don't know that they're open today if it's Good Friday. I know a couple of them are not. Let me check that. Give me just a moment.
[CUSTOMER][POSITIVE] Thank you so much I'd appreciate it.
[AGENT][NEUTRAL] OK, yes, so they are closed today for Good Friday. um, I can verify the number that you did call was that [PII]?
[CUSTOMER][NEUTRAL] No, uh, she actually didn't provide me with the phone number, so I had to search it up. It was the [PII].
[AGENT][NEUTRAL] Oh, I see.
[AGENT][NEUTRAL] OK, so that is us, that's, that is APL, um, so the policy number you gave me though, however, is through 90 degree benefits and we do work with them occasionally, um, as most sometimes they're part of a multi plan um let me give you this phone number let me know when you're ready if you'd like to write it down.
[CUSTOMER][NEUTRAL] Uh-huh, right.
[AGENT][NEUTRAL] Just so you've got it for them, OK, so that was [PII].
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And again to get to them, you would select option one.
[CUSTOMER][NEUTRAL] Would you by any chance know their PO box? Um, it's because it's an emergency. This patient does need to get scheduled right away. Uh, she has a nasal fracture and um I wanted to just run the insurance.
[AGENT][NEUTRAL] Well, it's
[AGENT][NEUTRAL] Mhm, um, I can try to get you their information definitely, but while we're on the phone I can go ahead to check to see if she does have a policy with us if you have her uh social I could search for her that way.
[CUSTOMER][NEUTRAL] Um, I don't think so. Let me see.
[CUSTOMER][NEUTRAL] Sorry, give me just one second.
[AGENT][NEUTRAL] No, no, you're fine.
[AGENT][NEUTRAL] We can also search just uh using the name, the first and last name, but this is social is typically a lot uh easier to pinpoint.
[CUSTOMER][NEUTRAL] OK, no problem, let me search it up, um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] So I don't have her social security on file um.
[AGENT][NEUTRAL] That's OK, we can go ahead and just try the name.
[CUSTOMER][POSITIVE] Yeah, I think is there any way? OK, OK, perfect, so.
[AGENT][NEUTRAL] Yeah, if, if you wouldn't mind spelling out the first and last name for me.
[CUSTOMER][NEUTRAL] Yeah, no problem. It's [PII]. So [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so [PII] was the last name.
[CUSTOMER][POSITIVE] Hopefully that's how it's going, uh-huh.
[AGENT][NEUTRAL] OK, got you. Alright, um, give me just a moment. I like these unique names. They're typically easier. It's harder when people have a name like, you know, [PII], and there's a million of them, so this should be easy to pinpoint. Give me just a moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and then this what you said um this was medical. OK, let's see, do you have um do you have her date of birth?
[CUSTOMER][NEUTRAL] Right, medical.
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][POSITIVE] Perfect. OK, so she does have a policy with us, um.
[AGENT][NEUTRAL] But here's the confusing part about this is that again as this is part of a multi plan it's possible that she does have other coverage elsewhere but I can go ahead and go over what she does have with us. So this is a limited indemnity medical plan so it is of course is limited and very specific as to what is and is not covered and just pays a set dollar amount, um, uh, depending on the covered procedure or office visit, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] There's no, it's not like a traditional major medical, there's no co-pay, deductible or authorization required, nothing like that. So if you give me one moment, I'll get this policy pulled up. But what was it that she was being seen for? I'm sorry.
[CUSTOMER][NEUTRAL] Um, so she's going to come in for a specialist office visit.
[AGENT][NEUTRAL] OK, let me see if that's something that would be covered, give me just a moment.
[CUSTOMER][NEUTRAL] So you said there's no copay, right? It's like uh no copay, no deductible, um, uh, OK.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes, it's a limited indemnity medical plan, yeah.
[AGENT][NEUTRAL] OK, and then uh was this in regard to um a sickness or something like that?
[CUSTOMER][NEUTRAL] No, so it was in regards to a nasal fracture and a and facial fracture.
[AGENT][NEUTRAL] A fracture, OK.
[AGENT][NEUTRAL] So of course I will let you know verification of coverage is not a guarantee of payment for claims. So again these policies can be very specific um as to what is and is not covered, so she does have.
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEUTRAL] A visit but it specifies for sickness.
[AGENT][NEUTRAL] And that's 5 visits that pays $75 per day or per visit rather.
[AGENT][NEGATIVE] Obviously this is not a wellness exam.
[AGENT][NEUTRAL] Diagnostic test, let me see, probably not.
[AGENT][NEUTRAL] Bear with me just a moment.
[CUSTOMER][POSITIVE] Yeah it's OK.
[AGENT][NEUTRAL] Yeah, OK, so it does specify if it were in regard to a sickness, um.
[AGENT][NEUTRAL] So it does not look like that would be a covered visit under this policy.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] What if the because what she told me is that she had went to emergency I know that you know of course they wouldn't know about her insurance, but what if like it was you know urgent and the emergency had recommended her to call us that wouldn't change anything right? because it's a.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] No. Um, so again, it's very specific. She does have like surgical benefits. So if it was something that came to something like that, uh, for surgery or anesthesia, she does have benefits for that. Or of course, you know, this, it's very specific. It is hospital confinement, um, intensive care, coronary care, wellness diagnostic, um,
[CUSTOMER][NEUTRAL] Um, no.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Being admitted to a hospital and then this uh sickness benefit, and of course the surgical, that's the extent of this policy. But again, it's possible that she might have coverage.
[AGENT][NEUTRAL] Through another uh carrier in which case I apologize that uh 90 degrees is closed today but if you need a response um I can give you their information. I have um.
[AGENT][NEUTRAL] I have an address for them it is for claims, but that's gonna be the only address I have.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, no problem, the [PII], right?
[AGENT][NEUTRAL] And I've
[AGENT][NEUTRAL] Yes, it's uh [PII]. Is that what you've got in [PII]?
[CUSTOMER][NEUTRAL] I don't have any information. She just provided me with the name of the insurance and so that's why I'm that's why I'm trying to get everything that I can, yeah, so.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Sure, I know it is very confusing and I apologize. I, I, these are such a mess, um, OK, so whenever you're ready I'll give you that mailing address and I've got their payer ID as well.
[CUSTOMER][NEUTRAL] OK perfect what's the mailing address?
[AGENT][NEUTRAL] That is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and that is in uh [PII], so that's [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then in [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alrighty um.
[AGENT][NEUTRAL] Did you want that payer ID as well?
[CUSTOMER][NEUTRAL] Uh, no, like that's fine. I think with the claims address we're OK, um, so 90 degrees is close today degrees.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And that's like a third party or?
[AGENT][NEUTRAL] No, um, I get, well, I guess technically we all kind of are again this is like part of a multi plan so that policy number she's clearly got something with them, um, I can't see it of course because that is through them, um, these multi plans are, you know, they've got several different kinds of policies through different carriers is typically how that works, so 90 degrees just holds one of those coverages.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and the PO box that you provided me with is that their claims address?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Yes, yes, I can give you ours too if you need it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, what is, um, well, I don't know.
[CUSTOMER][NEUTRAL] I don't know which PO box to put it under.
[AGENT][POSITIVE] I would do that one. I would do that one that you have, yes, I definitely would, um, the one for that's, uh, for 90 degrees.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, perfect, um, and can I get the benefits for a surgical, um, and hospitalization as well?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Absolutely. OK. So it's goes by hospital consignment. So it's a daily indemnity benefit um of $100 per day. And then the surgical benefit is going to be a bit different. So the base is $2000 per surgery. And then it depends on the surgery, the kind of surgery, it pays a percentage uh based off of that, which could be higher or lower. Does that make sense?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] So it's very confusing and I apologize. Um, the anesthesia benefit is 25% of whatever that surgical benefit would be.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, and you said for the specialist office visit it's only specify sickness, um, and then it's 5 visits per year and it covers, um.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] $75.
[CUSTOMER][NEUTRAL] $75 per day.
[AGENT][POSITIVE] Correct, or per visit, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and if our.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] If our like charge is higher than $75 and she would just be responsible for the rest.
[AGENT][NEUTRAL] Um, we don't say what is patient responsibility, that would be up to the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] But what if this appointment is medically necessary, um.
[CUSTOMER][NEUTRAL] That's, that's why I'm just like a little confused because maybe this patient does need might need surgery.
[AGENT][NEUTRAL] I understand, I understand.
[AGENT][NEUTRAL] Right, and again that there's a surgical benefit, um, however, that's why I think this is what this policy covers and so that's why I think especially if she has that information for 90 Degree that they would be the ones to talk to you about anything additional that she might have.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK then, well, thank you so much for your help. Um, can I just get your name, please?
[AGENT][NEUTRAL] You're welcome. I'm sorry, it's so confusing.
[AGENT][NEUTRAL] Uh, yeah, it's
[CUSTOMER][POSITIVE] No, it's OK, no problem.
[AGENT][NEUTRAL] It's [PII] did you have any other questions for me?
[CUSTOMER][NEUTRAL] Um, can I just get a reference number and that'll be it.
[AGENT][NEUTRAL] Yeah, it would just be my first name, last initial and today's date and for my last initial is A.
[CUSTOMER][POSITIVE] OK, thank you so much I appreciate your help.
[AGENT][POSITIVE] You're welcome of course thanks for giving us a call up you have a great weekend.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] Thank you too bye bye.
[AGENT][POSITIVE] Thanks bye bye.