AccountId: 011433970860
ContactId: 303566d2-ef7b-4709-87fc-fe6c8519ca09
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 204759 ms
Total Talk Time (AGENT): 89007 ms
Total Talk Time (CUSTOMER): 73573 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/303566d2-ef7b-4709-87fc-fe6c8519ca09_20250224T13:13_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, yes, my name is [PII], and I work with South East, Southeast Georgia physician Associates, and I'm just trying to verify benefits and if we, if we're in network with your insurance.
[AGENT][POSITIVE] Um, yes, ma'am. I can assist you with benefits. Um, first, could I get your name again and a good callback number?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] And a good contact number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII]. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] It is 0258.
[CUSTOMER][NEUTRAL] 2092.
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Um, it is on the card it's [PII], but it's for her son [PII].
[AGENT][NEUTRAL] OK. And his date of birth, please?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, and just let me advise you that verification of coverage does not guarantee payment of claims. Um, I'm showing the effective date on this policy was [PII]. The policy is still active. And is this for inpatient or outpatient benefits or an office visit?
[CUSTOMER][NEUTRAL] It's for an office visit.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][POSITIVE] OK, thanks for your patience. I'm still waiting for the benefits to come up.
[CUSTOMER][NEUTRAL] Oh OK, it's OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And what's your name? Sorry, I didn't, I didn't catch your name.
[AGENT][NEUTRAL] My name is [PII]. Um, it's spelled [PII] and my last initial is [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Because you
[AGENT][NEUTRAL] OK, I'm showing that under this policy, we cover office treatment services provided in office, but the co-pay is not covered. But for office treatments, we cover up to 9100 per calendar year and that's for the co-insurance and the deductible after the primary insurance processes the claim.
[CUSTOMER][POSITIVE] Got you OK.
[AGENT][NEUTRAL] OK. And as far as
[CUSTOMER][NEUTRAL] And can you, oh sorry, go ahead.
[AGENT][NEUTRAL] As far as the network goes, since we're secondary insurance, we go by the primary carrier's guidelines, so there is no network um with us.
[CUSTOMER][NEUTRAL] OK, so no network.
[AGENT][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Oh alrighty.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So when you say you guys based off the primary insurance, that's just it being that you guys just go off of whatever insurance they have.
[AGENT][NEUTRAL] Yes, ma'am. If the primary insurance does not cover a charge, then we don't cover it either.
[CUSTOMER][NEUTRAL] OK, so they don't cover alrighty.
[AGENT][NEUTRAL] OK. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] No, ma'am, that's it.
[AGENT][POSITIVE] OK. Well, I thank you again, [PII], for calling ATO. You have a great day. Mm bye.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thanks.