AccountId: 011433970860
ContactId: 598bf304-4b52-483c-8145-06c75b9b57a9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 363820 ms
Total Talk Time (AGENT): 170231 ms
Total Talk Time (CUSTOMER): 142928 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/598bf304-4b52-483c-8145-06c75b9b57a9_20250609T15:11_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, [PII], I am calling from Fort Laudon Medical Center.
[CUSTOMER][NEUTRAL] About a patient that he was a, [PII].
[CUSTOMER][NEUTRAL] Patient here and he has been transferred to another facility but I called earlier to um verify his insurance and I was told that it is active and everything but then when our utilization people reached out they were told that it was just a supplementary policy.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I guess I'm calling to find out exactly um.
[AGENT][NEUTRAL] What kind of policy it is.
[CUSTOMER][NEUTRAL] Yes, yes, is it his personal policy or OK, or if it's through his employer?
[AGENT][POSITIVE] Sure yeah I can get that pulled up.
[AGENT][POSITIVE] Yeah we can get that pulled up and take a look.
[AGENT][NEUTRAL] Absolutely. OK, um, I'm sorry, what was your name?
[CUSTOMER][NEUTRAL] OK, uh.
[CUSTOMER][NEUTRAL] Tell me what you need.
[AGENT][NEUTRAL] Yes ma'am, what was your name?
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] [PII], got it.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you and then uh can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alrighty thank you and then do you have that policy number?
[CUSTOMER][NEUTRAL] I do. It is 02605970.
[AGENT][NEUTRAL] OK, thank you. uh, what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] [PII] [PII]
[AGENT][NEUTRAL] Perfect, thank you for verifying all of that. OK, so this policy is active, uh, that effective date was [PII] and so this is a limited indemnity medical plan, so I would say it would be considered supplemental, um, can be used as major medical, of course, or as secondary if they have a primary, um, but with it being a limited indemnity plan.
[AGENT][NEUTRAL] Um, it is of course limited as to what is and is not covered and pays a set dollar amount per coverage procedure or office visit.
[CUSTOMER][NEUTRAL] Uh, you went out on me. It pays a set dollar amount on what? I'm sorry.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Yes, no, no, you're fine, um, per like covered office visit or uh procedure.
[CUSTOMER][NEGATIVE] You're going in and out on me.
[AGENT][NEUTRAL] Oh good. No, I'm sorry, can you hear me any better? Yes.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Alright, it pays to can you hear me now?
[AGENT][NEUTRAL] Yes, ma'am. Yes, no, I can hear you fine.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it pays the set dollar.
[AGENT][NEUTRAL] Yes, per covered procedure or office visit.
[CUSTOMER][NEUTRAL] OK, so if he, if he was here in our hospital, is it gonna cover anything like that?
[AGENT][NEUTRAL] What was he seen for?
[AGENT][NEUTRAL] Or what kind of treatment did he receive
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] I knew, I knew onset of Afib.
[AGENT][NEUTRAL] I'm sorry, what kind of treatment did he receive?
[CUSTOMER][NEUTRAL] his diagnosis was a new onset of afib.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And he went through our ER and was admitted as an observation and then he was transferred.
[AGENT][NEUTRAL] Got it. OK. Give me just a moment. Let me get that policy pulled up and we'll take a look.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alrighty here we are. I appreciate your patience. OK and then of course I will let you know uh verification of coverage is not a guarantee of payment for claims, um, so did he have to stay inpatient?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] He was an observation. He wasn't admitted as an inpatient at this facility.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Got it. OK, OK, so, uh, he does have specific benefits for emergency room, um, that is going to be, uh, that was $250 per day. Uh, there is a hospital admission benefit that was $1000 per day. And then if there were any confinements, that was $600 per day. And let me, that looks to be the extent of the benefits related to this.
[CUSTOMER][NEUTRAL] OK, and is this through his work?
[AGENT][NEGATIVE] Yes, this is absolutely going to be through his employer.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] OK, I think when the utilization people reached out I'm thinking they thought maybe he might have Medicare because they, they said it was a supplementary policy so they're thinking that he thought some other policy that's primary.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's possible. I'm not quite sure. I don't see that. I mean, I know some people only have this and which again can be used on its own, but I also know that some people do use it more as a supplement.
[CUSTOMER][NEUTRAL] Is what I'm thinking.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right then, thank you very much.
[AGENT][NEUTRAL] Of course. Was there anything else I can help you with?
[CUSTOMER][NEUTRAL] That's it. Can I get a reference for this call?
[AGENT][NEUTRAL] Yes, ma'am. That would just be my first name, last initial.
[CUSTOMER][NEUTRAL] Our fire alarms going off.
[AGENT][NEUTRAL] That's OK. I didn't know if that was a siren.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, and what was your first name?
[AGENT][POSITIVE] No worries.
[AGENT][NEUTRAL] Uh, it's uh [PII] and then my last [PII]
[CUSTOMER][NEUTRAL] And then you said today's date.
[AGENT][NEUTRAL] Yes, first name, last initial and today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, thank you very much.
[AGENT][POSITIVE] Of course, thanks for calling APL have a great rest of your day.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Alright you too bye bye.
[AGENT][NEUTRAL] Bye bye.