AccountId: 011433970860
ContactId: 584cd175-60b0-4875-a34d-421a7afbd8fc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 197190 ms
Total Talk Time (AGENT): 106360 ms
Total Talk Time (CUSTOMER): 54038 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/584cd175-60b0-4875-a34d-421a7afbd8fc_20250225T19:12_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I'm calling from Flores dermatology. My name is [PII], um.
[CUSTOMER][NEUTRAL] From Flo's rheumatology regarding a mutual patient for eligibility.
[CUSTOMER][POSITIVE] And benefits
[AGENT][POSITIVE] OK, yeah, I can check eligibility and benefits for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Policy number is 0232.
[CUSTOMER][NEUTRAL] 3384 M as in mom, L as in Lima, 8.
[AGENT][NEUTRAL] OK. Thank you. And what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Um, the name is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. So this policy actually terminated [PII]. If you'll give me one moment, I'll see if they have one that's active, might just be a different policy number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, they do have one that is currently active. Uh, let me know when you're ready and I'll give you this policy number.
[CUSTOMER][NEUTRAL] OK, give me one moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] OK, I'm ready.
[AGENT][NEUTRAL] OK, that is 02.
[AGENT][NEUTRAL] 353165.
[CUSTOMER][POSITIVE] Perfect. And
[AGENT][NEUTRAL] Mhm. And so
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, I wanted to know if this policy covers the primary co-pay.
[AGENT][NEUTRAL] Right, so, uh, and I'm sorry, this was for, uh, [PII], correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, OK, um, so yes, this is a secondary medical policy, so it is designed to help with co-pay, deductible and co-insurance after major medical pays. Uh, was this for, um, is it outpatient?
[CUSTOMER][NEUTRAL] Outpatient, yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just a moment, of course I will let you know verification of coverage is not a guarantee of payment for claims, and I can get that outpatient benefit for you. Uh, there's is on a.
[AGENT][NEUTRAL] So it is $2000 max per calendar year.
[AGENT][NEUTRAL] And then I will double check to see if any of that has been used.
[AGENT][NEUTRAL] OK, none has been used so far this year.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alrighty, so it does cover the copay, correct?
[AGENT][NEUTRAL] Yes, um, as long as major medical pays, uh, um, it helps with co-pay, deductible and co-insurance until it reaches that, uh, $2000 benefit maximum.
[CUSTOMER][NEUTRAL] OK, may I have a reference number, please?
[AGENT][NEUTRAL] Yeah, that would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII] And was there anything else I could help you with, [PII]?
[CUSTOMER][POSITIVE] Be thank you.
[AGENT][POSITIVE] OK, thanks for calling ATL. Have a great rest of your day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you bye bye.