AccountId: 011433970860
ContactId: 5de33ce5-85de-41b6-b9a6-8fdead9bde7e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 181419 ms
Total Talk Time (AGENT): 83894 ms
Total Talk Time (CUSTOMER): 45809 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/25/5de33ce5-85de-41b6-b9a6-8fdead9bde7e_20250625T20:11_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] and I'm calling from Athens Orthopedic Clinic, and I was calling to get eligibility and benefits for a patient.
[AGENT][NEUTRAL] I'm sure [PII] can assist you with benefits. Um, first, I'll need a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] 021.
[CUSTOMER][NEUTRAL] 896.
[CUSTOMER][NEUTRAL] 03.
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII], 43086.
[AGENT][NEUTRAL] And just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on the policy was [PII]. The policy is still active.
[AGENT][NEUTRAL] And is this for inpatient or outpatient benefits or an office visit?
[CUSTOMER][NEUTRAL] Office visit.
[AGENT][NEUTRAL] OK, let's see for services provided in office.
[AGENT][NEUTRAL] We cover up to 1500 per day and that's for the coinsurance and the deductible after the primary insurance processes the claim, but the co-pay for the office visit is not covered.
[CUSTOMER][NEUTRAL] And you said it covers up to how much?
[AGENT][NEUTRAL] Um, 1500 per day.
[AGENT][NEUTRAL] Yeah, and that's just for.
[CUSTOMER][NEUTRAL] OK, and is there a limit of how many days she gets?
[AGENT][NEUTRAL] No, ma'am, there isn't.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, well, um, does she need a referral or to see the specialist or?
[AGENT][NEUTRAL] No, since this is secondary insurance, we go by the primary insurance guidelines. So for us, um, we don't require a referral.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is this an accident wellness policy or just?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's secondary gap insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, if I could just get a reference number, please?
[AGENT][NEUTRAL] Um, yes, for the reference number, you can use my name and today's date. My name is [PII]. Um it's spelled [PII] E. My last initial is [PII] and today's date. Um, is there anything else I can assist you with?
[CUSTOMER][POSITIVE] No, that's it. Thank you so much.
[AGENT][POSITIVE] OK. OK. I thank you again, [PII] for calling APL. Have a great rest of your day. Mm bye.
[CUSTOMER][POSITIVE] Thank you, bye bye.
[AGENT][NEUTRAL] Mhm