AccountId: 011433970860
ContactId: 2b66e836-489c-4be8-b03a-9d5fd6c91f77
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 198839 ms
Total Talk Time (AGENT): 117971 ms
Total Talk Time (CUSTOMER): 60054 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/2b66e836-489c-4be8-b03a-9d5fd6c91f77_20250331T17:24_UTC.wav
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[AGENT][NEUTRAL] contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey [PII], I'm calling to verify benefits and um eligibility for a patient that's gonna have outpatient surgery.
[AGENT][NEUTRAL] OK, I can help with benefits and knowledgeability, with whom am I speaking, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Well, thank you. What is that policy number, please?
[CUSTOMER][NEUTRAL] Uh, policy number is 01661549.
[AGENT][NEUTRAL] Thank you and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] I appreciate that. Is there a callback number I could have in the event that's disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. It looks like the policy went into effect on [PII].
[AGENT][NEUTRAL] [PII], it is active. Now, the secondary or gap insurance has benefits for outpatient services. We will pick up the deductible, co-payment or co-insurance up to $4500 for calendar year. That's just the verification of benefits, not a guarantee of payment. There's also a $500 deductible that must be met.
[AGENT][NEUTRAL] On this, uh, on this policy first and uh.
[AGENT][NEUTRAL] It looks like that uh has not been met yet, so, um.
[AGENT][NEUTRAL] That would be, that would be, that would need to be paid first.
[CUSTOMER][NEUTRAL] Has anything been accumulated at all?
[AGENT][NEUTRAL] Uh, let's see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I'm sorry, could you give me his date of birth just one more time? I apologize.
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] OK, let's see, they, they all begin with a case just let me see if I can't find what.
[CUSTOMER][NEUTRAL] I know, I saw that.
[AGENT][NEUTRAL] What it is, yeah.
[AGENT][NEUTRAL] [PII], OK, [PII], excuse me. So, I take that back. I'm sorry, I was looking at.
[AGENT][NEUTRAL] OK, [PII] has paid his $500 deductible, so please excuse me. It looks like he has, uh, done that, so he has reached his, uh, deductible for his calendar year. [PII] has, so, uh, that would be fine. Um, we don't have to worry about that. And, uh, you would just file through his major medical first and then, uh, through us.
[CUSTOMER][NEUTRAL] OK. Do you know, um, and then the 4500, that was just the max.
[AGENT][NEUTRAL] That's the maximum, yes, that's correct, and, and again just the verification, not a guarantee of payment.
[CUSTOMER][NEUTRAL] What did you say that was?
[CUSTOMER][NEUTRAL] OK, alrighty, and uh do you know if authorization is required?
[AGENT][NEUTRAL] No, you wouldn't need authorization for us, uh, because we are just a secondary insurance. You do need to make sure that you're in, uh, network with your, uh, major medical, um, because that's what we do is pay the deductible, co-payment or co-insurance, yeah, but you don't, you don't have, have to have any um pre-authorization or anything like that with us.
[CUSTOMER][NEUTRAL] We are.
[CUSTOMER][NEUTRAL] OK perfect um and do I use your name in today's date or is there a uh separate call reference number?
[AGENT][NEUTRAL] No, no, it's my name in today's date.
[CUSTOMER][POSITIVE] Perfect. All right, thank you so much, [PII]. I hope you have a great day.
[AGENT][POSITIVE] Mhm. Thank you for contacting ATL.