AccountId: 011433970860
ContactId: 6371f7f5-35e3-4b31-9604-c4f4c24450b6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 250570 ms
Total Talk Time (AGENT): 131051 ms
Total Talk Time (CUSTOMER): 74397 ms
Interruptions: 2
Overall Sentiment: AGENT=1.3, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/18/6371f7f5-35e3-4b31-9604-c4f4c24450b6_20250618T13:11_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi uh my name is [PII]. I'm calling from a provider's office and I'm just needing to check um infertility benefits for a patient and see if there's any prior authorization that would be required.
[AGENT][POSITIVE] OK, sure, I can assist you with benefits, Miss [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And what is the name of the facility for my notes?
[CUSTOMER][NEUTRAL] Um, it's Axia Women's Health.
[AGENT][NEUTRAL] A X I A. How do you spell it?
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK. And may I have the patient's policy number, Miss [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It is 02350174.
[AGENT][NEUTRAL] OK, thank you, one moment.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] OK thank you.
[AGENT][NEUTRAL] All right, Ms. [PII]. OK, so, um, this is one of our secondary supplemental plan to the major medical and um what type of um facility is this, is this an outpatient facility or is it considered an office?
[CUSTOMER][NEUTRAL] Um, it's just in an office.
[AGENT][NEUTRAL] Office setting. OK, let me see what we cover in the office for this number.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, and this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer.
[AGENT][NEUTRAL] And it looks like we have an outpatient maximum of 1000 per covered person per calendar year, and this includes office procedures. Um, the only thing we do not cover under this policy is the office visit, but we do cover office procedures. Again, this is the secondary is set up to help with the deductibles, co-payment, and co-insurance from the major medical.
[CUSTOMER][NEUTRAL] OK, and if she were to have any uh in office procedures um related to infertility, would that be covered or does.
[CUSTOMER][NEUTRAL] Does it matter I guess what the procedures are for?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, um, infertility is usually a sickness. Um, so we do cover for sickness or accidents and, uh, it has to be approved by the major medical, um, we are just a second there, we're gonna follow major medical.
[CUSTOMER][NEUTRAL] OK, so I, I'm gonna check with their primary first so if their primary covers it and processes it, then you will too as long as it's not but not office visits just procedures, is that correct?
[AGENT][NEUTRAL] Procedures and it has to be applied, yes, correct, and it has to be applied towards the deductible co-payment and co-insurance in order for us to pick it up from there. That's what we cover.
[AGENT][NEGATIVE] And again this is that's not guarantee.
[CUSTOMER][NEUTRAL] OK, um, what about ultrasounds?
[AGENT][NEUTRAL] And that is a procedure. Any ultrasounds, any um x-rays, any injections, those are procedures. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] All right, well thank you so much I appreciate that do you just have a reference number for me?
[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] Um, yeah, how do you spell your name?
[AGENT][NEUTRAL] That's [PII].
[CUSTOMER][POSITIVE] OK, thank you so much I appreciate that you have a good day.
[AGENT][POSITIVE] You're welcome. You as well. Thank you for calling ATO. Have a good day, Miss [PII].
[CUSTOMER][POSITIVE] Thanks you too bye bye.
[AGENT][POSITIVE] Thank you. Goodbye.