AccountId: 011433970860
ContactId: 39d61757-2d06-449d-8e78-6736767d967d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 182979 ms
Total Talk Time (AGENT): 108097 ms
Total Talk Time (CUSTOMER): 59653 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/39d61757-2d06-449d-8e78-6736767d967d_20250110T19:19_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for contacting ATM. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon, this is [PII] calling from provider's office to check on a patient's eligibility and benefits.
[AGENT][POSITIVE] Yeah, I can certainly help with eligibility and benefits. What's that policy number, please?
[CUSTOMER][NEUTRAL] Yes, the policy number is.
[CUSTOMER][NEUTRAL] 1456796
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] It's [PII] and the date of birth is [PII].
[AGENT][POSITIVE] I think, thank you very much. And is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Thank you. The, oh, I appreciate that. Thank you. The policy went into effect on [PII]. It is active. Uh, this policy has, um,
[CUSTOMER][NEUTRAL] It's a direct line.
[AGENT][NEUTRAL] Uh, $500 for calendar year to pick up the deductible, co-payment or co-insurance for in and out of hospital settings, treatment within a physician's office, cancer treatment, labs, durable medical. That's just a verification of the benefits, not a guarantee of payment.
[AGENT][NEUTRAL] And it looks like for the calendar year [PII], none of those benefits have been used. Is there anything in particular that I can tell you about the policy besides uh
[CUSTOMER][NEUTRAL] Uh, yeah, actually I need the benefits for an MRI and CT scan.
[AGENT][NEUTRAL] In and out.
[AGENT][NEUTRAL] OK, that would be outpatient and we pick up the deductible, co-payment or co-insurance from their major medical, up to $500 per calendar year. Again, just a verification, not a guarantee of payment. It doesn't look like they have used any of those benefits for this current year. So what you're going to do is, um, you would, uh, file through their major medical first and then through us as we're a secondary insurance.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, so you're telling that uh the, the patient has a $500 guarantee here and nothing has been made out of that, right?
[AGENT][POSITIVE] That is right.
[CUSTOMER][NEUTRAL] OK, so is this like a limited benefit plan?
[AGENT][NEUTRAL] No, this is a secondary or gap insurance.
[CUSTOMER][NEUTRAL] Uh, secondary. So there's no like co-pay, coinsurance, deductible, and out of pocket for this number?
[AGENT][NEUTRAL] That's correct, for up to $500 for calendar year.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, $500 for MA. Thank you. And can I have your name again?
[AGENT][NEUTRAL] Yes, my name is [PII]. The first letter of my last name is [PII]. We're gonna use that today's date as a reference. Is anything else at all I can help with?
[CUSTOMER][NEUTRAL] OK send it.
[CUSTOMER][NEUTRAL] Uh, yeah, I need the group name and the group number.
[AGENT][NEUTRAL] The group, uh.
[AGENT][NEUTRAL] Name and number for this?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] The group number is 21086.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And it's Abar Inc, A B as in boy, N A R Inc.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you so much for getting all the information, [PII].
[AGENT][POSITIVE] Mhm, OK, there's nothing else I can help with and thank you for contacting APL. Have a good day.