AccountId: 011433970860
ContactId: 5edb25f0-b1b1-4691-bb32-aec6d60f5b47
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 235639 ms
Total Talk Time (AGENT): 110087 ms
Total Talk Time (CUSTOMER): 92054 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/5edb25f0-b1b1-4691-bb32-aec6d60f5b47_20250604T15:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, um, this is [PII]. I work at Providence Hospital. I'm finding out if the patient still has this coverage.
[AGENT][NEUTRAL] OK, yeah, I can check that eligibility for you. uh, [PII], can I get a good call back number from you first in case we're disconnected please?
[CUSTOMER][NEUTRAL] Uh, yes, [PII].
[AGENT][NEUTRAL] OK, thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Uh yes, it's 02337230.
[AGENT][NEUTRAL] OK and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Uh [PII]'s shot, um, I'm sorry, [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that. Uh, so this policy is active. Effective date was [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so is this only for if he was an inpatient in the hospital, or do we build this for outpatient test?
[AGENT][NEUTRAL] Uh, let me check the actual benefits for this policy. It is a limited indemnity medical plan, um, so they are quite a bit different as to what is and is not covered. Um, bear with me just a moment, let me get this pulled up.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Right down there
[CUSTOMER][NEUTRAL] Oh right behind you and then take the next right and it straight.
[AGENT][NEUTRAL] OK, I appreciate your patience. Um, alrighty, so of course I will let you know verification of coverage is not a guarantee of payment for claims. So essentially just a breakdown of these benefits. He does have a hospital consignment, uh, intensive care, coronary care, um.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] First occurrence being admitted to a hospital, but he does have uh outpatient sickness benefits. Um, is that what this is in regard to?
[CUSTOMER][NEUTRAL] Um, no, let me look real quick. Oh, actually it's like a colonoscopy actually.
[CUSTOMER][NEUTRAL] Would that be something we would uh
[AGENT][NEUTRAL] Oh, OK, let me see if there's a diagnostic testing benefit. Let's see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this policy does not offer any sort of diagnostic testing benefit.
[CUSTOMER][NEUTRAL] OK, so can you just give me a rundown uh real quick so is for what kind of benefit is it just in general so if he comes in again I can kind of make a quick little note.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yeah, the only thing that's really for outpatient I would think is this uh sickness benefit, um, and that would be like you know for an office visit.
[CUSTOMER][NEUTRAL] OK, we don't do office visits at the hospital, so, uh, what about like ER if he ever came into the ER, does it cover that?
[AGENT][NEUTRAL] I don't see anything for emergency room. Uh, let me see.
[AGENT][NEUTRAL] Um, yes, that actually that does fall under, um, the outpatient sickness benefit.
[CUSTOMER][NEUTRAL] OK, so for the hospital that might be the only thing and and if he was admitted was is that another option, um.
[AGENT][NEUTRAL] Hustle the ad or excuse me, admission, let me see. I do believe there was one, but let me check that.
[AGENT][NEUTRAL] No, it's simply that confinement, so that would be more inpatient.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, well thank you um I will make a little note so we don't have to call each time thank you.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] No, you're fine it's very confusing. Was there anything else I can help you with?
[CUSTOMER][POSITIVE] Yeah, no, that's good, thank you very much.
[AGENT][POSITIVE] Alrighty well thanks for giving us a call [PII] have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][NEUTRAL] Alright, bye-bye.