AccountId: 011433970860
ContactId: 64999481-9f22-486e-abd7-5d331721cef6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 238699 ms
Total Talk Time (AGENT): 105478 ms
Total Talk Time (CUSTOMER): 95749 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/64999481-9f22-486e-abd7-5d331721cef6_20250502T15:43_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thank you for calling ATL.
[AGENT][NEUTRAL] This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I was calling to verify member's eligibility and benefits, please.
[AGENT][NEUTRAL] OK, I can help you with the eligibility and benefits for a patient. May I please get your name and your callback number just in case the call is dropped.
[CUSTOMER][NEUTRAL] Yes, my name is [PII]. Callback number is [PII]. It's a direct line.
[AGENT][NEUTRAL] OK, thank you, Ms. [PII]. And what is the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] I am calling from AdventHealth Tampa.
[AGENT][NEUTRAL] OK, thank you. And may I please get the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[CUSTOMER][NEUTRAL] And I believe the policy number is 02559229 ML8.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, I do show that [PII] does have an active policy with us. The effective date of her policy is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this is just to verify her benefits. It's not a guarantee of payment. She has a supplemental insurance policy with us that helps with deductible, co-pay, and co-insurance.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] She has an inpatient calendar year benefit amount of $6000 and then she also has an outpatient benefit amount per calendar year of $6000 to go towards deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, deductible, co-pay, or co-insurance?
[CUSTOMER][NEUTRAL] Coinsurance. OK, now she doesn't need authorization, correct?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] No, ma'am, because it's not the primary insurance.
[CUSTOMER][NEUTRAL] OK, so it is just a supplement insurance.
[AGENT][POSITIVE] Yes ma'am, you're right.
[CUSTOMER][NEUTRAL] OK, is, is her plan Medlink select group?
[AGENT][NEUTRAL] Yes, it is medley.
[CUSTOMER][NEUTRAL] Medical supplement? OK. All right, that's what I had to check and see.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] All right then, um, all right, and it will cover the primary's deductible.
[AGENT][POSITIVE] Yes ma'am, it does help with deductible copay or co-insurance.
[CUSTOMER][MIXED] OK, but the limit is $6000 for outpatient?
[AGENT][NEUTRAL] It is 6000 per calendar year for outpatient.
[CUSTOMER][NEUTRAL] OK, calendar year. OK, OK then, do you have a reference number for our call?
[AGENT][NEUTRAL] Ma'am, you can use my name [PII].
[AGENT][NEUTRAL] And today's date.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Perfect. Alright, thank you so much for your help today.
[AGENT][POSITIVE] You're very welcome, Miss [PII] we appreciate you calling APL is that everything that I can help you with before we go?
[CUSTOMER][NEUTRAL] That's all.
[AGENT][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] Yes ma'am, that's all I needed.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] OK, well you have a wonderful weekend and thank you for calling APL.
[CUSTOMER][POSITIVE] Alright, thank you.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.