AccountId: 011433970860
ContactId: 3ffe9e65-2b56-4ed5-bd05-d0d8cd9f2d1f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 235419 ms
Total Talk Time (AGENT): 145339 ms
Total Talk Time (CUSTOMER): 48886 ms
Interruptions: 0
Overall Sentiment: AGENT=2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/16/3ffe9e65-2b56-4ed5-bd05-d0d8cd9f2d1f_20250516T19:10_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII], and I'm calling from Diagnostic Center of Miami, and I was calling for benefits, please.
[AGENT][NEUTRAL] OK, [PII], you're only needing benefit information for a member. You do not need eligibility, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh yes, both.
[AGENT][POSITIVE] Both? OK, I can help you with both. And what is a good callback number for you, please, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] 023-31253ML8
[AGENT][NEUTRAL] OK, thank you. One moment, [PII], while I get the member's information pulled up please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And should care any information that is provided will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Um, [PII], [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, and again, any information provided will be a verification of benefits and not a guarantee of payment. I do show that Miss uh [PII] is the subscriber on the supplemental policy and it is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what type of benefit information again do you need for her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Um, his office.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, so on this supplemental policy, office visits are not covered?
[AGENT][NEUTRAL] However, should she receive some form.
[CUSTOMER][NEUTRAL] Even if
[AGENT][NEUTRAL] Go ahead with your question.
[CUSTOMER][NEUTRAL] We built this office with no consultation.
[AGENT][NEUTRAL] OK, an office visit isn't covered under this policy?
[AGENT][NEUTRAL] If there is treatment rendered within the office, that is something the treatment could be reviewed under her outpatient benefit maximum that a visit is not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][POSITIVE] Sounds good.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you need her outpatient benefit maximum for treatment?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so the outpatient benefit maximum per calendar day for covered outpatient services is $500.
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person per calendar day.
[CUSTOMER][NEUTRAL] Per day.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If you all do file a claim with us, [PII] for her on this policy, we will have to have a copy of her primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] And then once we have processed our claim here we do have a portal in which you should be able to check the claim status in if you go to [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Well thank you [PII] and have a good day.
[AGENT][POSITIVE] Oh, you're very welcome. Yes, ma'am, [PII] can I help you with anything else?
[CUSTOMER][NEUTRAL] No, that'd be all.
[AGENT][POSITIVE] OK, well thank you again for calling APL and I hope you have a nice weekend.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.