AccountId: 011433970860
ContactId: 441e54a3-f3b2-4d8c-83ed-99382058bbb7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 330230 ms
Total Talk Time (AGENT): 114506 ms
Total Talk Time (CUSTOMER): 113892 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/441e54a3-f3b2-4d8c-83ed-99382058bbb7_20250320T21:48_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello [PII], my name is [PII]. I have a question regarding a patient's eligibility.
[AGENT][NEUTRAL] I'm sure, [PII], I can assist you with benefits. Um, first, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Of course. It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] Uh, we have 026-06896.
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Patient's name is, sorry, [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK. Thank you and just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII] and the policy is still active. Um, is this for inpatient or outpatient benefits or an office visit?
[CUSTOMER][NEUTRAL] It's an office visit with the specialist, OB OBGyne.
[AGENT][NEUTRAL] OK, for services provided in office, we cover up to $50 per visit and she gets 4 visits per calendar year.
[CUSTOMER][NEUTRAL] Do you cover maternity?
[AGENT][NEUTRAL] Um, yes, ma'am.
[AGENT][POSITIVE] That, but it's included um for all office visits, for all services provided in office, including maternity. Yes, ma'am. Um, it's covered under this benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] To be 4 visits per year and then.
[AGENT][NEUTRAL] $50 per visit.
[CUSTOMER][NEUTRAL] Ultrasounds, are they
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And only 4 visits per year?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK. And if they're pregnant, is there another way to
[CUSTOMER][NEUTRAL] Just in case, so they would have to pay out of their pocket after that, is that my understanding.
[AGENT][POSITIVE] Yes, ma'am, that's correct.
[CUSTOMER][NEUTRAL] OK. And do you cover ultrasounds?
[AGENT][NEUTRAL] Um, will it take place in the office or outpatient facility?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] In the office.
[AGENT][NEUTRAL] Um, an office, yes, ma'am. It is covered. It's covered under the $50.
[CUSTOMER][NEUTRAL] Oh, so only up to 4 for that as well, right?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And is there a payer ID?
[CUSTOMER][NEUTRAL] That we would
[AGENT][NEUTRAL] Um, yes. The pay ID is 64556.
[CUSTOMER][NEUTRAL] OK. And it goes to American Public Life, is that correct?
[AGENT][POSITIVE] Yes, ma'am, that's correct.
[CUSTOMER][NEUTRAL] And then the address that I show on the card says attention IMA Inc [PII]. That's where claims go, correct?
[AGENT][POSITIVE] Yes, that is, that's correct.
[CUSTOMER][NEUTRAL] OK, and then the policy number I gave you is correct as well? 0260.
[AGENT][NEUTRAL] Yes, ma'am. That's her policy number.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Is there a group number or anything else?
[CUSTOMER][NEUTRAL] We would need
[AGENT][NEUTRAL] Um, yes, ma'am. Let me get the group number for you.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] The group number is 70073.
[CUSTOMER][NEUTRAL] Yeah, and would they cover her delivery if she's pregnant? I honestly don't know.
[AGENT][NEUTRAL] OK, for inpatient hospital.
[AGENT][NEUTRAL] One moment, I'm waiting on my system.
[CUSTOMER][POSITIVE] No problem. Thank you.
[AGENT][POSITIVE] Mm. No problem.
[AGENT][NEUTRAL] Yes, admissions, um, we cover up to 5000 per admission and she gets 1 per calendar year.
[CUSTOMER][NEUTRAL] And then that would be her responsibility after.
[AGENT][POSITIVE] Yes, ma'am, that's correct.
[CUSTOMER][NEUTRAL] OK, so I'm assuming this isn't a typical where they have deductible and co-insurance or any of that, right? It's just the 50 for 4 visits for the 5000.
[AGENT][NEUTRAL] For inpatient, yes, ma'am.
[CUSTOMER][NEUTRAL] For the hospice.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All righty. Thank you so much. I appreciate your help.
[AGENT][NEUTRAL] OK, is there anything else that I can assist you?
[CUSTOMER][NEUTRAL] Oh, in the server.
[CUSTOMER][NEUTRAL] I'm sorry, reference number for our call.
[AGENT][NEUTRAL] Yes, for the reference number, you can use my name and today's date. My name is [PII]. Um it's spelled [PII] and my last initial is [PII] and today's date.
[CUSTOMER][POSITIVE] Thank you so much, [PII] You have a wonderful day.
[AGENT][NEUTRAL] You do the same, [PII]. Thank you for calling APL. Mm bye.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.