AccountId: 011433970860
ContactId: 3f9ca931-d58e-4f77-bd9f-4354b9768f60
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 239179 ms
Total Talk Time (AGENT): 117451 ms
Total Talk Time (CUSTOMER): 75609 ms
Interruptions: 1
Overall Sentiment: AGENT=1.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/3f9ca931-d58e-4f77-bd9f-4354b9768f60_20250107T15:40_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 calling from a provider's office and I was calling to uh get some benefits information about the patient's plan.
[AGENT][POSITIVE] OK, I'm happy to check on benefits for you today. Do you have their policy number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 764184.
[AGENT][POSITIVE] Alright, thank you so much let me pull this up.
[AGENT][NEUTRAL] And if I could grab your first name and a callback number, please?
[CUSTOMER][NEUTRAL] Sure, my name is [PII] and my phone number is [PII].
[AGENT][POSITIVE] Thank you so much, [PII]. What is the uh patient name and date of birth, please?
[CUSTOMER][NEUTRAL] It is [PII] [PII].
[AGENT][POSITIVE] Alright, thank you so much. So patient plan is active. The effective date on this is [PII].
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Uh, this is a limited benefit medical plan, so a hospital indemnity plan. It's going to pay a set amount just depending upon what the patient's being seen or treated for.
[CUSTOMER][NEUTRAL] OK, this would be for an MRI.
[AGENT][NEUTRAL] OK, let's see what it pays towards.
[AGENT][NEUTRAL] Do do do. OK.
[AGENT][NEUTRAL] Alright, [PII], bear with me one second. I need to pull this member's policy certificate. It's a little older here, 1 2nd.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I get it.
[CUSTOMER][NEUTRAL] Get me the.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, so it looks like the patient gets a maximum of 5 office visits in a year, and the outpatient uh benefit payment for an office visit is $75 per visit. It looks like for diagnostic testing, there is a benefit on the plan. It shows up to $250. That would be the max it would pay towards that.
[CUSTOMER][NEUTRAL] OK, so, um, this would be secondary. So if the patient's primary has a actually a $250 co-pay, would, would this plan as secondary pick up that $250.
[AGENT][NEGATIVE] Yeah, for the secondary then it would pick that up absolutely we just unfortunately don't have their primary info.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] And you said that um but it would only do that one time per year, is that correct?
[AGENT][NEUTRAL] Uh, yes, it looks like maximum testing minimum.
[AGENT][NEUTRAL] Um, it actually says per test. So there is no limit as far as diagnostic testing, yeah, how much they can have. The only limit I see on here is just for an actual office visit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it. OK, all right, and could I get a call reference number?
[AGENT][NEUTRAL] Absolutely, [PII]. That's gonna be my name with my last initial in today's date. My name again is [PII], that's [PII] The last initial to my name is [PII].
[CUSTOMER][POSITIVE] Perfect thank you so much I appreciate your help.
[AGENT][POSITIVE] You're welcome. Have a great day.
[CUSTOMER][NEUTRAL] OK, bye.
[AGENT][NEUTRAL] Bye.