AccountId: 011433970860
ContactId: 5ec23978-dc7f-470a-b85b-5f6b0cbed440
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 176419 ms
Total Talk Time (AGENT): 88222 ms
Total Talk Time (CUSTOMER): 74293 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/18/5ec23978-dc7f-470a-b85b-5f6b0cbed440_20250618T17:43_UTC.wav
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[AGENT][POSITIVE] Thank you for contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon, [PII]. My name is [PII]. I'm looking to verify eligibility and benefits for members gap policy.
[AGENT][NEUTRAL] OK, I can help with eligibility and benefits. What's that policy number, please?
[CUSTOMER][NEUTRAL] Yes, so the policy number I have here is 02597285.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Yes, so I have [PII] with the date of birth of [PII].
[AGENT][NEUTRAL] Can I please have a a callback number in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Yes, that's going to be [PII].
[AGENT][NEUTRAL] Thank you. The policy went into effect on [PII]. It is active. This is a secondary or gap insurance with in and out of hospital benefits. Is there anything in particular that I can tell you about the secondary or gap insurance? Any inpatient, outpatient?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, so it'll be the coverage basis for the outpatient.
[AGENT][NEUTRAL] OK, we will pick up the deductible, co-payment or co-insurance for outpatient services, including, uh, cancer treatment, uh, treatment within a physician's office, uh, durable medical equipment, uh, independent labs. What isn't covered cushion is the office visit. The office visits are not covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that is just a verification that's not a guarantee.
[CUSTOMER][NEUTRAL] And so
[CUSTOMER][NEUTRAL] Understood so that that there's no maximum to that amount it'll just pick up whatever the whatever remains of the primary?
[AGENT][NEUTRAL] Yes, it's just, yeah, the deductible co-payment of phone insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] 100% covered. OK, understood then, [PII] so no coverage maximum, um, just 100% of whatever amount that doesn't include the office visit. Great, so I should have excellent.
[AGENT][NEUTRAL] Well, yeah, that's what that $6000 is it's up to $6000.
[CUSTOMER][NEUTRAL] OK, up to $6000 OK.
[AGENT][NEUTRAL] Yeah, uh-huh, yeah, and that's again just a verification identity.
[CUSTOMER][NEUTRAL] Up to 6000 and have they met anything to have.
[CUSTOMER][NEUTRAL] Yeah, and have they met anything of that 6000 for this year?
[AGENT][NEUTRAL] Yeah, so
[AGENT][NEUTRAL] Uh, yeah, for the calendar year [PII], just let me check here really quickly.
[AGENT][NEUTRAL] I'm sorry, it's a little bit difficult to hear. So, uh, for [PII], it does, uh, [PII] has used $1200 of her benefits, but nobody else has used either.
[CUSTOMER][NEUTRAL] Uh huh
[CUSTOMER][NEUTRAL] No, of course.
[AGENT][NEUTRAL] We just $1200 of your benefits so far.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And she hasn't used any of the other benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Understood.
[CUSTOMER][NEUTRAL] OK, just making a note of that. Alright then [PII] should be wrapping up now. May I have a reference number for this call?
[AGENT][NEUTRAL] Yes, my name is [PII]. The first letter of my last name is [PII]. We'll use that today.
[CUSTOMER][POSITIVE] And today's date excellent then. Well thank you so much for your time, really appreciate it and I hope you have a great day, mhm.
[AGENT][NEUTRAL] OK, there's nothing else to help with. Thanks for contacting A.