AccountId: 011433970860
ContactId: 59ff4d46-e050-4568-a242-5ef205998995
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 274720 ms
Total Talk Time (AGENT): 88211 ms
Total Talk Time (CUSTOMER): 53386 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/59ff4d46-e050-4568-a242-5ef205998995_20250507T17:24_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I'm just calling to check if my patient has used any benefits this calendar year.
[AGENT][NEUTRAL] OK, I can check um the balance of the calendar year for you. Uh, can I please get your callback number, Ms. [PII], just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] OK, and then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] [PII], date of birth is [PII].
[CUSTOMER][NEUTRAL] And the member ID is 02367353.
[AGENT][NEUTRAL] OK, let me look her up real quick.
[AGENT][NEUTRAL] It's gonna be just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, and we're gonna be looking for benefits for the calendar year, um.
[AGENT][NEUTRAL] OK, I do show and you were looking for Ms. [PII] is that or or [PII]?
[CUSTOMER][NEUTRAL] No, I'm sorry, yeah, [PII].
[AGENT][NEUTRAL] [PII], um, she still has her $50 deductible left to pay, and this is just to verify benefits. It's not a guarantee of payment. She also has her $500 benefit for the calendar year left for the year of [PII]. She's not used anything.
[CUSTOMER][NEUTRAL] OK, perfect. Does she have any history of FMX or panel from another year?
[AGENT][NEUTRAL] Let me look real quick.
[AGENT][NEUTRAL] [PII] does not have any claims on file.
[AGENT][NEUTRAL] So she's not used to anything.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] OK. Um, and last thing again, does this plan accept assignment of benefits?
[CUSTOMER][NEUTRAL] I'm coordination of benefits.
[AGENT][NEUTRAL] No, we don't do coordination of benefits.
[CUSTOMER][NEUTRAL] Um, if she has another insurance.
[CUSTOMER][NEUTRAL] Um, which would you guys be primary, would you know?
[AGENT][NEUTRAL] No, um,
[AGENT][NEUTRAL] It's not done that way with our company it's just you just file the claim whether she has another one or not and then the claim is based how the um benefits and fee schedule are.
[CUSTOMER][NEUTRAL] OK, and [PII] would be, uh, this, this, uh, policy to be scheduled, correct?
[AGENT][NEUTRAL] Right, so it's the UCR, usual customary reasonable.
[CUSTOMER][NEUTRAL] OK, UCR. OK, sounds good, ma'am. Can I have a reference number, please?
[AGENT][NEUTRAL] Yes, ma'am. You can use my name and today's date.
[CUSTOMER][POSITIVE] Awesome thank you so much, [PII]. You have a great rest of your day.
[AGENT][POSITIVE] You too, Ms. [PII]. You have a good rest of your week and thanks for calling APL.