AccountId: 011433970860
ContactId: 68159351-1770-4cb9-9761-d0fbb36b966e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 225710 ms
Total Talk Time (AGENT): 99983 ms
Total Talk Time (CUSTOMER): 81804 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/68159351-1770-4cb9-9761-d0fbb36b966e_20250107T16:15_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, so my name is [PII]. I'm calling with Gastro Med LLC, and I just wanted to confirm, uh, coverage and, um, see if you have a.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Claim for a patient we were just giving your information so just wanted to confirm that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, sure, Ms. [PII], I can assist you with eligibility and claim status, and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] May I have the patient's policy number?
[CUSTOMER][NEUTRAL] I have 02010880 Mother Lima number 8.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] I have [PII] [PII].
[AGENT][NEUTRAL] OK, perfect. Thank you. All right. And for the eligibility, we have an effective date of [PII]. Um, it is active at the moment and this is one of our secondary supplemental plans to the major medical. And for the claim, what is the date of service?
[CUSTOMER][NEUTRAL] Date of service was [PII] for 1563.
[AGENT][NEUTRAL] Mm let me check on that really.
[AGENT][NEUTRAL] OK, bear with me. I do have a claim. Let me see if it's your claim.
[AGENT][NEUTRAL] They put the documents.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] No, we have not received that claim as of today.
[CUSTOMER][NEUTRAL] OK, just to confirm, um, just see what are the benefits for the patient outpatient benefits?
[AGENT][NEUTRAL] Yeah, OK, and this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer and it looks like um this policy has an outpatient maximum of $500 per day.
[CUSTOMER][NEUTRAL] OK, and does that include office visits and procedures?
[AGENT][NEUTRAL] No, it doesn't include office at all. This is for outpatient facilities, ERs, diagnostic center, um, sur surgical centers.
[CUSTOMER][NEUTRAL] OK, and how about for for the physician performing the service at the surgical center?
[AGENT][NEUTRAL] Or outpatient facilities.
[AGENT][NEUTRAL] If it's a surgical center, yes. It, it depends on the place of service.
[CUSTOMER][NEUTRAL] OK, so nothing done at the doctor's office facility, yes, OK, perfect. Alright, so could I please have a reference number?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We don't have reference numbers, Ms. [PII]. You can use my name in today's date if you will. Do you need the spelling or any other information?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] It's a [PII]?
[AGENT][NEUTRAL] [PII] last initial [PII]
[CUSTOMER][NEUTRAL] And alright perfect and um just a question um if uh as part of the procedure a uh pathology was done would that also be a cover expense?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] If it was an outpatient facility, yes.
[CUSTOMER][POSITIVE] OK, all right, perfect, thank you very much you have a great day, so take care.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] You're welcome and thank you for calling ATL. Have a good day. Bye-bye.
[CUSTOMER][NEUTRAL] Alright bye bye.