AccountId: 011433970860
ContactId: 4d7359bc-93d4-4fdd-bf75-0167e22d8807
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 274779 ms
Total Talk Time (AGENT): 126038 ms
Total Talk Time (CUSTOMER): 92962 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/05/4d7359bc-93d4-4fdd-bf75-0167e22d8807_20250505T13:49_UTC.wav
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[AGENT][NEUTRAL] For contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII], and I'm calling from L OBGYN, and I'm trying to verify uh benefits and eligibility for a new patient.
[AGENT][NEUTRAL] I can help with benefits and eligibility and uh what is that policy number, please?
[CUSTOMER][NEUTRAL] I see D like David 43732686.
[AGENT][NEUTRAL] OK. Um, let me see if I can't find it by their name. Uh, how do you spell the, the last name, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And the first name, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, let's see.
[CUSTOMER][NEUTRAL] Yes
[AGENT][NEUTRAL] OK, um, is there maybe a social security number that I could look up? It's not coming out by the name.
[CUSTOMER][NEUTRAL] I don't have one and I'm trying to provide a portal um let me just take a look so the card that they provided looks a little different, um.
[CUSTOMER][NEUTRAL] Let me see do do do, uh, let me give you a different policy number. I'm sorry, um 02594474.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Try that.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] And is this for medical or dental?
[CUSTOMER][NEUTRAL] Medical.
[AGENT][NEUTRAL] OK, so the policy went into effect on [PII]. It is active.
[AGENT][NEUTRAL] Let's see what she has here. Now, is there anything in particular you mentioned outpatient benefits. Um, is there anything in particular that I could help with or?
[CUSTOMER][NEUTRAL] Um, so.
[CUSTOMER][NEUTRAL] Specialist office visit.
[CUSTOMER][NEUTRAL] For new patient OBGYN.
[AGENT][NEUTRAL] OK. Yes, there is, there's usually a.
[CUSTOMER][NEUTRAL] They'll pay if there's anything.
[AGENT][NEUTRAL] Usually there is a physician's office um benefits here, so let's see.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, there is um uh.
[AGENT][NEUTRAL] Treatment, uh, within the physician's office, um, it will pay, uh, let's see.
[AGENT][NEUTRAL] There's one visit per calendar year.
[AGENT][NEUTRAL] Um, it will pay approximately $125. That's just a verification of the benefits, not a guarantee of payment, um.
[AGENT][NEUTRAL] I'm not showing that that has happened this year, um, but that's what this does. This is, this is a hospital indemnity policy and it pays that flat rate benefit, um.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] For, uh, yeah, so, um, it doesn't really, uh, pay for, um, uh, anything else, you know, just, it just pays that flat benefit for a very, very specific service.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and that's what that would be.
[CUSTOMER][NEUTRAL] OK, so if it
[CUSTOMER][NEUTRAL] Oh, I'm, I'm so sorry to cut you off. So are you saying that the patient is allotted one doctor's office visit per calendar year because it's a limited plan?
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][NEUTRAL] OK, alrighty, and it only pays 125 max allowable, um, and then is there any way to tell if our um provider's office is in network?
[AGENT][NEUTRAL] Well, because it is a limited benefit policy, we don't have a network. They're allowed to go wherever they want to, um, and that's, that's just because they're, you know, it's just gonna pay that certain amount no matter where they go. So there is no network, they can go to any doctor's office uh that they like.
[CUSTOMER][NEUTRAL] OK, I got you alright and is there a reference number for our call today?
[AGENT][NEUTRAL] Yes, my name is [PII]. The first letter of my last name is [PII]. We're gonna use that today's date as a reference. Is there anything else at all that I can help with?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] No thank you so much appreciate it.
[AGENT][NEUTRAL] OK, thank you for contacting ATO.