AccountId: 011433970860
ContactId: 347963ae-80d4-4c43-b788-e28a329afa25
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 327100 ms
Total Talk Time (AGENT): 142951 ms
Total Talk Time (CUSTOMER): 117769 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/30/347963ae-80d4-4c43-b788-e28a329afa25_20250530T14:59_UTC.wav
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[AGENT][POSITIVE] Thank you for contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my friend's name is [PII] and the initial for the last name is [PII]. I'm calling from Doctor [PII]'s office and I'd like to check eligibility and benefits for member please.
[AGENT][NEUTRAL] [PII], I can help with eligibility and benefits. What's that policy number that we're looking at today?
[CUSTOMER][NEUTRAL] I'm sorry, but I can, I can hardly hear you. Can you please repeat that again?
[AGENT][NEUTRAL] Oh, can you hear me a little
[AGENT][POSITIVE] Yes, um, my name is [PII], and, uh, [PII], I can certainly help with eligibility and benefits. What is that policy number, the policy number that we're looking at today so I can get that eligibility and benefits for you.
[CUSTOMER][NEUTRAL] Sure. It's 026225887.
[AGENT][NEUTRAL] Thank you. And the uh insured's name and date of birth, please?
[CUSTOMER][NEUTRAL] Remember his name is um [PII].
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And is there a callback number please that I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] Is there a uh maybe a callback number I can have in case we're uh disconnected?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and it's a direct line.
[AGENT][NEUTRAL] Thank you. Um, [PII], the policy went into effect on [PII].
[AGENT][NEUTRAL] [PII] and it is active. You mentioned wanting to know about benefits. Um, this is a hospital indemnity policy.
[AGENT][NEUTRAL] Is there any particular thing that I can help you with? Office visits, urgent care, the ER, something like that?
[CUSTOMER][NEUTRAL] Yeah, so, um, I would like to check if the mental health covered or not. It will be, ah, like a specialist office visit, a regular specialist office visit, uh, will be rendered in an outpatient facility and re billing professional. So I'd like to know if it's covered or not and if yes, what are the benefits for it?
[AGENT][NEUTRAL] OK, yes. So, as I mentioned before, this is a hospital indemnity policy and what it does is it will pay a flat rate benefit for the office visit.
[AGENT][NEUTRAL] There are 4 of those office visits throughout the calendar year, and it's what it will pay for.
[AGENT][NEUTRAL] Uh, is, um, 4 office visits at $50 each. Now, that is just a verification benefit.
[AGENT][NEUTRAL] Not a guarantee of payment, but that is what the policy will do for that office visit to Dr. [PII]'s office, it will pay the $50 for that. Anything else and above and beyond that, uh, would not be the policy wouldn't pay that, but it will pay that flat rate benefit of $50.
[AGENT][NEUTRAL] And right now I'm not showing that [PII] has used any of her benefits, so that would all be available.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I just need to make sure that I got it correctly. So the member will be paying $50.
[AGENT][POSITIVE] Um, no, no, this is just the benefit.
[CUSTOMER][NEUTRAL] And the claim, you are not quite sure either.
[AGENT][NEUTRAL] Right, I'm sorry, um, [PII], the, uh, the benefit is $50 so they would be paying anything above that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. OK, got it.
[AGENT][NEUTRAL] Now, is there anything else at all I can tell you about this um hospital indemnity policy?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh no, I think that would be all. Uh, just one more question. Um, I'm not quite sure either our provider is a network with the members scan or not so.
[CUSTOMER][NEUTRAL] Ah, is it something that we can check or it doesn't matter either in network or out of network?
[AGENT][NEUTRAL] Uh, the, the policy doesn't have a network because it is a flat rate benefit discount policy. There is no network, so they can go to any, any provider at all that will pay exactly the same.
[AGENT][NEGATIVE] So that, so there is no network and they can go to any provider at all.
[CUSTOMER][POSITIVE] OK, yeah, I got it.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] No network. perfect. Uh thank you so much indeed. I think that will be all. If you can just please provide me with a call reference number.
[AGENT][NEUTRAL] Yes, my name is [PII], and the first letter of my last name is [PII], and that's, that's our reference. Yeah, that's our reference number. It's my name.
[CUSTOMER][NEUTRAL] Uh yeah.
[CUSTOMER][POSITIVE] Yeah, I'm sorry.
[CUSTOMER][POSITIVE] Just well
[CUSTOMER][NEUTRAL] OK, um, I'm sorry, one last question, uh, can you please provide me with the payer ID that we uh should send the claim to?
[CUSTOMER][NEUTRAL] Electronically?
[AGENT][NEUTRAL] Yes, yes, the payer ID.
[AGENT][NEUTRAL] It's 64.
[AGENT][NEUTRAL] 556.
[CUSTOMER][NEUTRAL] 645-556.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Perfect. That will be all. Thank you so much indeed for your help today and enjoy the rest of your show.
[AGENT][POSITIVE] OK, thanks for contacting AT have a good.