AccountId: 011433970860
ContactId: 3b225f1a-e0b0-4171-b8d0-a43d29b8ae78
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 446940 ms
Total Talk Time (AGENT): 174378 ms
Total Talk Time (CUSTOMER): 105068 ms
Interruptions: 2
Overall Sentiment: AGENT=1.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/3b225f1a-e0b0-4171-b8d0-a43d29b8ae78_20250124T17:02_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. My name is [PII].
[AGENT][NEUTRAL] OK, hi [PII], this is [PII].
[CUSTOMER][NEUTRAL] Hi, I'm trying to verify benefits for a patient.
[AGENT][POSITIVE] OK, I can help you with benefits. What is your call back number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, and then what is the patient's name?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. And then what is uh [PII]'s date of birth? I'm sorry, policy number?
[CUSTOMER][NEUTRAL] 02583455 ML 8.
[AGENT][NEUTRAL] OK, let me look up her policy real quick.
[AGENT][NEUTRAL] OK, I do see that [PII] does have an active policy and her effective date is [PII].
[AGENT][NEUTRAL] And this is just to verify her coverage. It's not a guarantee of payment. She has a supplemental insurance policy that is billed secondary to the primary. It's a gap insurance that helps with deductible, co-pay and co-insurance.
[AGENT][NEUTRAL] She has an inpatient benefit amount per calendar year of $3000 and then she has an outpatient per calendar day benefit amount of $350.
[CUSTOMER][NEUTRAL] OK, and do you cover regardless of place of service like office visit for a specialist?
[AGENT][NEUTRAL] Let me look on her policy to see if she has office visits covered.
[CUSTOMER][NEUTRAL] Um, DME please.
[AGENT][NEUTRAL] She does have DME.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, let me see.
[AGENT][NEUTRAL] I'm going to pull in her policy real quick to see about the office visits.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome. It's gonna be just a second so my computer can load it for us.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Of course, it's taking its sweet little time.
[CUSTOMER][NEUTRAL] Hello
[AGENT][NEUTRAL] OK, and let me see uh finally came in, so let me look at it and see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] It should be great as well.
[CUSTOMER][NEUTRAL] Yeah, it's for 3 minutes. That's what I figured.
[CUSTOMER][NEGATIVE] Or uh yeah actually no.
[CUSTOMER][NEUTRAL] Then you put the 013, yeah.
[CUSTOMER][NEUTRAL] He had a.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] He's like
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so on this um policy, a covered outpatient facility is a free-standing outpatient surgery center, hospital emergency room, hospital outpatient facility, MRI facility, physical therapy facility, or urgent care. So office visits are not covered under this policy.
[CUSTOMER][NEUTRAL] Yeah, I know
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] BS
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, um, what about DME DME.
[CUSTOMER][NEUTRAL] 3 or 5
[AGENT][NEUTRAL] Durable medical equipment is covered.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] Even if place of service is home and be less professional.
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] Or just for hospitals and stuff like that?
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] don't have
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] It's not covered for home. It's covered, um, is, if it's used to serve a medical purpose in respect to treatment of an outpatient covered charge.
[CUSTOMER][NEUTRAL] OK, OK, so it's um.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] So for example, a mask for a CPAP device is not going to be covered.
[AGENT][NEUTRAL] OK, it says um durable medical equipment that can be withstand repeated use and is not disposal and is used to serve a medical purpose with respect to treatment of an outpatient cover charge if applicable. It's not used to a person in the absence of a sickness or injury and is appropriate for use and primarily used with, oh, it does say within the home.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] But you're pretty much good, you get it. You just have like, you just need practice on this.
[CUSTOMER][NEUTRAL] And then once
[CUSTOMER][POSITIVE] Limit you're you're gonna go even faster.
[CUSTOMER][NEUTRAL] Because it's like the same thing over and over.
[CUSTOMER][NEUTRAL] Because you're only working Wednesdays and Fridays, right, yeah.
[AGENT][NEUTRAL] And it's not implantable. So yes, she can use the uh durable medical equipment at home for sickness or injury.
[CUSTOMER][POSITIVE] It should be good.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] So DME will be covered.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, I have a reference number for the call?
[AGENT][NEUTRAL] Yes, you can use my name it's [PII] and today's date.
[CUSTOMER][POSITIVE] Thank you and have a nice day.
[AGENT][POSITIVE] You have a good day too. Have a good weekend thanks for calling ATL.
[CUSTOMER][NEUTRAL] Same to you bye.
[AGENT][POSITIVE] All right. You take care, [PII].
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Bye-bye.