AccountId: 011433970860
ContactId: 682a2acb-d1e7-4732-8fdf-4d6e8d6418b9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 362100 ms
Total Talk Time (AGENT): 99429 ms
Total Talk Time (CUSTOMER): 146352 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/682a2acb-d1e7-4732-8fdf-4d6e8d6418b9_20250409T13:44_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good morning [PII]. My name is [PII] and I'm calling from Atlantic Sine Center. I'm calling in to verify my patients out of network benefits.
[AGENT][NEUTRAL] OK, I can help you with benefits. Could you repeat your name? I didn't catch it.
[CUSTOMER][NEUTRAL] Yes, it's [PII] Last name [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Yes, that is.
[CUSTOMER][NEUTRAL] 02595525
[AGENT][NEUTRAL] And can I get a good callback number just in case I lose you?
[CUSTOMER][NEUTRAL] Yes, that's [PII].
[AGENT][NEUTRAL] OK, thank you. And the patient name and date of birth?
[CUSTOMER][NEUTRAL] He has a picture
[CUSTOMER][NEUTRAL] Patient name is.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] The date of birth, give me one second.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And is this benefits for outpatient services or?
[CUSTOMER][NEUTRAL] Yes, outpatient.
[CUSTOMER][NEUTRAL] Office visit specialist office visit?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] This is not a guarantee of payment. It's a basic outline of the policy. Uh, I show the policy is effective [PII]. It's currently active.
[CUSTOMER][NEUTRAL] Uh, she
[AGENT][NEUTRAL] And let me see.
[AGENT][NEUTRAL] So for a physician's office visit, it will pay a maximum of $50 per day to a max of 4 days per calendar year.
[CUSTOMER][NEUTRAL] For physicians
[CUSTOMER][NEUTRAL] $50 per day
[CUSTOMER][NEUTRAL] For the specialist office.
[AGENT][NEUTRAL] Uh, it does, it doesn't specify. It's just physician's office, period.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] So it's OK, one second, it's $50 per visit and there's 4 visits maximum per year.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is this the type of Medicaid plan?
[AGENT][NEUTRAL] No, it's a hospital indemnity plan, so it's like a supplemental policy.
[CUSTOMER][NEUTRAL] OK, so, OK.
[CUSTOMER][NEUTRAL] It is supplemental plan. So by any chance would the patient have another insurance? Like, would this be the patient's primary insurance or?
[AGENT][NEUTRAL] Um, let me see if I can see anything else on file.
[AGENT][NEUTRAL] I don't show any other major medical coverage.
[CUSTOMER][NEUTRAL] I don't show any other.
[CUSTOMER][NEUTRAL] OK, so this would be the patients only insurance, and I'm sorry, can you repeat the type of plan it is?
[AGENT][NEUTRAL] It's a hospital indemnity plan.
[CUSTOMER][NEUTRAL] OK, and there's like no deductible, no out of pocket, and no co-insurance. It's just the $50 flat out.
[AGENT][NEUTRAL] Yes, that's correct. And then there's no network either, so.
[CUSTOMER][POSITIVE] Yes, that's correct
[CUSTOMER][NEUTRAL] OK, by any chance, is there a sub, what is that called a summary plan of the patient's health benefits I can get a copy of?
[AGENT][NEUTRAL] Um, we have a schedule of benefits page. Let me see.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Yeah, I should be able to send that to you. Do you have a fax number?
[CUSTOMER][NEUTRAL] Yeah, I should be able to send that to you. Do you have a.
[CUSTOMER][NEUTRAL] Yes, that fax number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I will send you a schedule of the benefits for this policy.
[CUSTOMER][NEUTRAL] OK, I will send you a schedule.
[CUSTOMER][NEUTRAL] OK, and that'll be all for today. Is there a, well, actually, no, since I have one more question, since this is a hospital amenity plan, what are the benefits for, uh, services done in the ambulatory surgical facility?
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] So it looks like.
[AGENT][NEUTRAL] For that benefit, surgery in a hospital, outpatient facility, or free-standing outpatient surgery center, um, it's $500.
[CUSTOMER][NEUTRAL] $500
[AGENT][NEUTRAL] Per day, a maximum of one day per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One
[CUSTOMER][NEUTRAL] OK, and I think that is all for today. Can I have the reference number?
[AGENT][NEUTRAL] A reference number is just my name, [PII], first initial to last name, [PII], and today's date.
[CUSTOMER][NEUTRAL] my
[CUSTOMER][POSITIVE] OK, [PII], thank you so much. I appreciate it and I hope you enjoy the rest of your day.
[AGENT][POSITIVE] OK, thank you for calling APL. Have a great day.
[CUSTOMER][POSITIVE] Thank you for calling ATL
[CUSTOMER][POSITIVE] Thank you bye bye.