AccountId: 011433970860
ContactId: 5b7945e1-3df3-4058-b830-71b7f651cb26
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 313640 ms
Total Talk Time (AGENT): 178472 ms
Total Talk Time (CUSTOMER): 118950 ms
Interruptions: 3
Overall Sentiment: AGENT=0.7, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/5b7945e1-3df3-4058-b830-71b7f651cb26_20250124T20:02_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] I'm sorry, what is your name, please?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][POSITIVE] Oh thank you so I'm calling to verify uh eligibility on a patient with our practice please.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, sure, I can assist you with the eligibility. May I have your name?
[CUSTOMER][NEUTRAL] My name's [PII].
[AGENT][NEUTRAL] And Miss [PII], may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] Thank you. And what is the name of the provider or facility?
[CUSTOMER][NEUTRAL] Is Beach Family Medical.
[AGENT][NEUTRAL] An office?
[CUSTOMER][NEUTRAL] That's the office mhm.
[AGENT][NEUTRAL] OK. Thank you. And may I have the patient's policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] It's um 02585505.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Perfect. Thank you, [PII]. All right, and you say you need eligibility. We have an effective date of [PII]. It is active at the moment and this is one of our limited hospital indemnity plan.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, let me give you the benefit information.
[CUSTOMER][NEUTRAL] When you say that is this only this is hospitalization?
[AGENT][NEUTRAL] No, it has additional benefits, which I can go ahead and give you uh the benefits for an office visit. It's just a limited policy and it pays like an indemnity amount, which is a flat amount, OK? So let me go ahead and get that benefit for you. And this is not a guarantee.
[CUSTOMER][NEUTRAL] OK, mhm.
[CUSTOMER][NEUTRAL] I just wanna make sure we're participating in it. Can I, I'll give you my NPI number?
[AGENT][NEUTRAL] Uh, well, we don't have any network, um, we don't have any networks. Um, if the provider participates with multi-plan, they get that additional discount, um, but we're not.
[CUSTOMER][NEUTRAL] Would that help?
[AGENT][NEUTRAL] Contracted. Um, we pay any provider as long as they send us a claim.
[CUSTOMER][NEUTRAL] So in other words, if we so if we participate in multi plan this is the the uh the appointment will get paid.
[AGENT][POSITIVE] It will not get fully paid. It will pay the maximum benefit allowed by the policy. Um, let me go ahead and give you benefits so we can, yeah, so we can go ahead, because, yeah, it's easier whenever we, we have the benefit out, out there.
[CUSTOMER][NEUTRAL] Because it's a flat rate.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and this is not a guarantee of payment, just the verification of coverage. And we have a $75 per visit, maximum of 5 visits per year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so what that means is $75.
[AGENT][NEUTRAL] We will cover $75 of the visit. If there's
[CUSTOMER][NEUTRAL] So in other words, you'll cover 75 anything all that comes out of the patient's pocket.
[AGENT][NEUTRAL] Correct. Anything remaining will come out of the patient's pockets unless they have a different policy like a major medical that they want to use or another policy they want to use. But this one is just a limited policy and it's an indemnity policy, which it pays flat amount. Mhm. And there's no network.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, mhm, and you said something, uh how many, how many visits are they allowed?
[AGENT][NEUTRAL] 5 per year.
[CUSTOMER][NEUTRAL] 5 visits per year, does that include a well visit or or?
[AGENT][NEUTRAL] No, this is for sickness or injury only. Um, it doesn't cover, yeah, preventative.
[CUSTOMER][NEUTRAL] OK, and what about an annual?
[AGENT][NEGATIVE] Mmm. It's not covered under this policy.
[CUSTOMER][NEUTRAL] Annual is not covered, OK.
[CUSTOMER][MIXED] OK, just sick visits.
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] OK, and is there a copay on the 6 visits?
[AGENT][NEUTRAL] No, it pays a flat amount, so it will be the $75.
[CUSTOMER][NEUTRAL] So they just pay 75 per visit.
[AGENT][POSITIVE] Mhm correct.
[CUSTOMER][POSITIVE] Got it OK.
[CUSTOMER][NEUTRAL] All right, so anything else I need to know?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Um, not in my end. Is there any other questions you have for me?
[CUSTOMER][NEUTRAL] What about uh when it comes to lab work or um pharmacy?
[AGENT][NEUTRAL] This one doesn't cover lab work. Um, pharmacy is usually handled by Pharmavale.
[CUSTOMER][NEUTRAL] And how pharmacy is.
[CUSTOMER][NEUTRAL] Farmville.
[AGENT][NEUTRAL] Farmavale. Mhm. Yes, Farmavale. Mhm.
[CUSTOMER][NEUTRAL] Farmervale Farm Farmerville, what does that mean? They can go to a pharmacy but it goes through that's their um default. What is that?
[AGENT][NEUTRAL] Their insurance company. The insurance uh company for pharmacy is a pharma for any medications. Mhm.
[CUSTOMER][NEUTRAL] Their insurance
[CUSTOMER][NEUTRAL] I see.
[CUSTOMER][POSITIVE] OK, all right, I think you've helped me. Can I just get a reference number from you?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will. Do you need the spelling of my name or any other information?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, I'm good, thank you so much.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. You have a good day. If you have any other questions, just feel free to call us back, OK, Mr. [PII].
[CUSTOMER][POSITIVE] Thank you you too.
[CUSTOMER][POSITIVE] Thank you I appreciate it thank you.
[AGENT][NEUTRAL] You're welcome. No.