AccountId: 011433970860
ContactId: 3c9427c0-ff66-4e43-b675-521b6f1273bf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 274510 ms
Total Talk Time (AGENT): 123005 ms
Total Talk Time (CUSTOMER): 63870 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/17/3c9427c0-ff66-4e43-b675-521b6f1273bf_20250417T18:38_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I'm trying to get benefits for a patient that's having a procedure at our facility.
[AGENT][POSITIVE] Yeah, I can check those benefits for you. uh, what was your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK, [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] I do pull it up here.
[CUSTOMER][NEUTRAL] It is oops.
[CUSTOMER][NEUTRAL] 02595600
[AGENT][NEUTRAL] OK, and then what was the name and date of birth for the member, please?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that, [PII]. Uh, so this policy is active. Effective date was [PII], and this is a limited indemnity medical plan, so it is set to pay a set dollar amount per covered procedure and or office visit. Uh, what kind of procedure were we needing to check coverage for?
[CUSTOMER][NEUTRAL] He's having a colonoscopy and an endoscopy.
[AGENT][NEUTRAL] OK, one moment please, let me check that for you.
[AGENT][NEUTRAL] Bear with me just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. And of course, I will let you know verification of coverage is not a guarantee of payment for claims. Uh, was this in a, uh, like a regular physician's office facility? Or was this in a hospital?
[CUSTOMER][NEUTRAL] Um, no, it's an outpatient ambulatory surgery facility.
[AGENT][NEUTRAL] Ambulatory, OK.
[AGENT][NEUTRAL] And is this regarding um an accident or a sickness?
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, OK, so the reason I ask, of course this policy is very um specific as to what is and is not covered um so I do not see outpatient ambulatory facility as a covered facility um he does have a diagnostic testing benefit, but I don't.
[AGENT][NEUTRAL] I think that's, let's see. No, that's going to be for um medical imaging tasks. So neither of those um
[AGENT][NEUTRAL] Procedures are going to be covered under this policy.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] Doctor's office that referred him to us and sent him over to our facility for procedures claiming that they spoke to someone.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] A named [PII] and said that no authorization is required for either of these.
[AGENT][NEUTRAL] That's correct authorization is not required.
[CUSTOMER][NEUTRAL] Procedures and they're covered.
[CUSTOMER][NEGATIVE] But they're not covered.
[AGENT][POSITIVE] Correct.
[AGENT][MIXED] Again, there is a diagnostic testing benefit. however, it is limited to MRI CAT scan, uh, PET scan, CT scan, um.
[AGENT][NEUTRAL] And there's some follow up tests regarding those, but colonoscopy is not gonna be a covered procedure.
[CUSTOMER][NEUTRAL] For endoscopies.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then can I get a reference number for this call?
[AGENT][NEUTRAL] Sure, uh, that would just be my first name, last initial, and today's date, and so that's, uh, my name is spelled [PII]
[AGENT][NEUTRAL] And was there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] Um, no, that's it.
[AGENT][POSITIVE] Alright well thanks for giving us a call. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][POSITIVE] Thanks bye bye.