AccountId: 011433970860
ContactId: 4d558292-164f-46b2-a4a4-3dd3fe15b665
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 391859 ms
Total Talk Time (AGENT): 180820 ms
Total Talk Time (CUSTOMER): 63581 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/4d558292-164f-46b2-a4a4-3dd3fe15b665_20250528T19:37_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, yes, I'm calling from the doctor's office. I need to check benefits for a patient please for specialist office visit.
[AGENT][NEUTRAL] OK, I can help you with benefits. May I please get your number and your name and the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] OK, my name is [PII]. My phone number is [PII]. That's my direct line and I'm calling from Doctor [PII]'s office.
[AGENT][POSITIVE] Thank
[AGENT][NEUTRAL] OK, thank you very much. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] OK, [PII] [PII], and the policy number, give me one second.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It is 02283875.
[AGENT][NEUTRAL] OK, let me pull up that policy real quick.
[AGENT][NEUTRAL] All right, I do show that [PII] does have an active policy. The effective date of his policy is [PII], and this is just to verify his benefits. It's not a guarantee of payment. He has a supplemental insurance policy that's billed secondary to the primary.
[AGENT][POSITIVE] It helps with deductible, co-pay and co-insurance.
[AGENT][NEUTRAL] Uh, he has an inpatient, uh,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Benefit amount of $5000.
[AGENT][NEUTRAL] And then he also has an outpatient benefit amount of $500 per occurrence.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Let me see if he has.
[CUSTOMER][NEUTRAL] OK, do you guys pay, yeah, for the office visits for specialists?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Let me check to see if he has office visits on this policy.
[AGENT][NEUTRAL] Give me just a moment. I'm gonna have to pull up the policy certificate and look at it, so it's gonna need to download for me so it's gonna be just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm just having to scroll through. It's gonna be just a minute so I can find it if he has it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, on his policy.
[AGENT][NEUTRAL] It covers in emergency room, urgent care facility.
[AGENT][NEUTRAL] A freestanding ambulatory center, diagnostic testing.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So, no, no office visit, right?
[AGENT][NEUTRAL] It pays, um, OK, so physician outpatient treatment in a freestanding uh physician's office.
[AGENT][NEUTRAL] It is $25 per visit, a maximum of 4 visits per covered person per calendar year.
[AGENT][NEUTRAL] So it pays $25.
[AGENT][NEUTRAL] For a physician's office, and he can get for a year.
[CUSTOMER][NEUTRAL] OK, when you mean this office, it so it does cover specialist office visits.
[AGENT][NEUTRAL] Yes, physicians, um, it's, this is what it, it states, is a location in which a physician routinely or on appointment basis provides health examination, diagnosis and treatment of sickness or injury due to an accident on an ambulatory basis for the purpose of this rider.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This does not include a hospital freestanding outpatient surgery center or urgent care center. So it does only cover for physician's office.
[CUSTOMER][NEUTRAL] OK, and you told me you guys only cover how much? 25?
[AGENT][NEUTRAL] Yes, it said 25.
[AGENT][NEUTRAL] And he gets a visit 4 times a year.
[CUSTOMER][NEUTRAL] OK, how many visits does they have remaining?
[AGENT][NEUTRAL] Let me check real quick.
[AGENT][NEUTRAL] He's not used anything for the year of [PII].
[CUSTOMER][POSITIVE] OK, perfect. OK, may I have your name?
[AGENT][NEUTRAL] My name is [PII], it's [PII]
[CUSTOMER][NEUTRAL] And a reference number?
[AGENT][NEUTRAL] Yes ma'am, that would be my name and today's date.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're very welcome. You have a wonderful day. Is that everything I can help you with Miss [PII]?
[CUSTOMER][POSITIVE] Yes, that will be it.
[AGENT][POSITIVE] OK, you take care and thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][NEUTRAL] Bye-bye