AccountId: 011433970860
ContactId: 4e503f9d-265a-4985-bb20-2e34b1fb7272
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 366190 ms
Total Talk Time (AGENT): 177163 ms
Total Talk Time (CUSTOMER): 114132 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/4e503f9d-265a-4985-bb20-2e34b1fb7272_20250620T20:17_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. I am just calling to verify eligibility and benefits for a patient.
[AGENT][NEUTRAL] OK, you're needing eligibility and benefit information for one member, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] Uh, my name is [PII]. That's spelled [PII] [PII]. Last initial is [PII].
[AGENT][NEUTRAL] Thank you. And see, what is your callback number?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] The policy number?
[CUSTOMER][NEUTRAL] It starts with D as in Delta 41601927.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, thank you. Now, that is not an APL policy number, that is for IMA or 90 degree benefits. Is that who you were trying to reach?
[AGENT][NEUTRAL] Or does the member also have a policy with APL?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Ah, OK, because actually it says medical ID number and the other one is policy number. Um, so the policy number is 026.
[AGENT][NEUTRAL] And what's the policy?
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] 40638.
[AGENT][NEUTRAL] 38 are the last two numbers. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, thank you. One moment while I get the member's information pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I can see any information that is provided today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, this is for [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I do show that he is a subscriber on this limited benefit plan.
[AGENT][NEUTRAL] And this policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And did you, did you say you do or do not need benefit information? I'm sorry.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, yeah, need the general benefits for specialist office visit, also, general, I mean, surgery done in the office. Just general benefits. We don't have CPT codes yet.
[AGENT][NEUTRAL] OK, so on this limited benefit plan again, this is not major medical insurance. The outpatient accident and sickness treatment benefit for a physician's office is $100 per day, maximum of 4 days per calendar year per covered person.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And for accident and excuse me, accident and sickness surgery benefit.
[AGENT][NEUTRAL] In a physician's office, that is a benefit of $250 per day, maximum of 2 days per calendar year per covered person.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, by the way, for the $100 maximum for 4 days.
[AGENT][NEUTRAL] That is the
[AGENT][NEUTRAL] Yes, it's a $100 per day benefit, maximum of 4 days per calendar year per covered person for a physician's office visit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK. Is that also includes the um office surgery done by a specialist?
[AGENT][NEUTRAL] That's the second benefit that I gave you, the $250.
[AGENT][NEUTRAL] It's a separate benefit for surgery in a physician's office.
[CUSTOMER][NEUTRAL] Oh, OK, and you mentioned maximum of 2 days per calendar year?
[AGENT][POSITIVE] Uh-huh. Correct. For the accident and sickness surgery benefit. Yes, that is correct.
[CUSTOMER][NEUTRAL] OK, and I'm so sorry. I just wanna make sure, um, this $100 is this the insurance covers or the patient will pay this $100?
[AGENT][NEUTRAL] That would be the benefit that the insurance would pay if approved.
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] Oh alright, thank you for that. Um, uh, letting me know about this. um, thank you. Can I have the reference number for your call today, please?
[AGENT][POSITIVE] Yes, ma'am. You're welcome.
[AGENT][NEUTRAL] Yes, ma'am, you would use my name along with today's date. Again, my name is [PII] Um, if you will end up filing a claim with us for this number, once the claim has been processed, we do have a portal that you should be able to check claim status in.
[AGENT][NEUTRAL] And the website that you would go to for that is located at [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, probably. OK, alright, uh, just let him know about this. Thank you again and you have a wonderful weekend. Bye.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] OK, well you're welcome. Well, hope you have a wonderful weekend as well, and if that's all I can help you with, thank you again for calling APL.
[CUSTOMER][NEUTRAL] Mhm OK.
[AGENT][NEUTRAL] Bye-bye.