AccountId: 011433970860
ContactId: 68d911de-f617-47ec-9cbd-53b1e06be721
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 373690 ms
Total Talk Time (AGENT): 171818 ms
Total Talk Time (CUSTOMER): 101836 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/68d911de-f617-47ec-9cbd-53b1e06be721_20250127T20:16_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm with Hunt Regional Medical Center in [PII], and I'm needing to see if I can get some benefit information as well as see if an authorization is required for a CT scan.
[AGENT][NEUTRAL] OK, yes, we could definitely take a look at those benefits and see if authorization is required. Um, can, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, our callback number is [PII].
[AGENT][NEUTRAL] Alright, thank you. Do you have the policy number?
[CUSTOMER][NEUTRAL] Um, so the, uh, policy number that I have is D43731210.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so that's actually not one of our policy numbers, Chatham, that's gonna be through, uh, they're called 90 Degrees. Do you maybe have their social? I could search for them that way.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, let me check here, hold on just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] My system is only showing me the last 4. Let me see if I can find it a different way. I do apologize.
[AGENT][NEUTRAL] No, you're fine um if not I can try searching just uh with their name.
[AGENT][NEUTRAL] And if I'm unable to find them that way I can always just uh transfer you to 90 degrees.
[CUSTOMER][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] OK, yeah, I have the patient's name and date of birth if we could try that way.
[AGENT][NEUTRAL] Sure, um, if you wouldn't mind spelling out the first and last name for me.
[CUSTOMER][NEUTRAL] Yes, so first name is [PII] Last name [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. One moment, let me try that.
[AGENT][NEUTRAL] OK, and uh, what does, what state, uh, does [PII] live in?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], OK, let me see.
[AGENT][NEUTRAL] Alright and you said you did have his date of birth?
[CUSTOMER][NEUTRAL] Yes, his date of birth is [PII].
[AGENT][POSITIVE] Perfect. OK, so I did find that policy. Uh, let me know when you're ready. I can give you that policy number.
[CUSTOMER][NEUTRAL] OK, yeah, what's that policy number?
[AGENT][NEUTRAL] OK, it is 02.
[AGENT][NEUTRAL] 504,700.
[CUSTOMER][POSITIVE] Awesome thank you so much.
[AGENT][NEUTRAL] Of course, OK, and so it is currently active. Uh, the effective date was [PII], and so this is a limited indemnity medical plan, so it is just designed to pay a set dollar amount uh per office visit or procedure, um, no copays, no deductibles, and no authorization is required.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] right.
[CUSTOMER][NEUTRAL] All right, and um can you tell me what the benefit pays for on a CT scan?
[AGENT][NEUTRAL] Yes, give me just a moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] All right. And of course, I will let you know chat and verification of coverage is not a guarantee of payment for claims. Uh, so that CT scan would fall under their diagnostic benefit, uh, which pays $100 for that benefit.
[CUSTOMER][NEUTRAL] $100. Um, is there like any kind of like usages or like coverage per visit that they have?
[AGENT][NEGATIVE] Um, I don't believe this one offers visits at all. Let me see.
[CUSTOMER][NEUTRAL] Or limitations as I should put it probably.
[AGENT][NEUTRAL] No office visit.
[AGENT][NEUTRAL] No, there's this plan doesn't offer uh office visits. Um, so this plan is, um, strictly offers hospital admission, hospital confinement, um, surgical benefits regarding an accident or sickness. There's the diagnostic testing benefit and there's also a follow up diagnostic testing benefit if that's required.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, um, and then like does it have any like usages or anything like they're only allowed to have so many per year or anything like that?
[AGENT][NEUTRAL] Oh, I see what you're asking. I'm sorry. Um, you mean for the, uh, diagnostic testing?
[CUSTOMER][NEGATIVE] Yes, yes, I'm sorry, it came out completely wrong.
[AGENT][NEUTRAL] Oh no, that's OK. I heard office visit because we get that one quite a bit and I was just like, not for this one.
[AGENT][NEUTRAL] OK, give me just a moment. Let me look at that fine print. Typically there are uh limitations, so let me check that just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so that is a maximum for the diagnostic testing, maximum of 2 days per calendar year per covered person.
[CUSTOMER][POSITIVE] OK awesome.
[AGENT][NEUTRAL] Sorry about the confusion.
[CUSTOMER][NEUTRAL] No, no, no, it is my fault, um, so let's see and then.
[AGENT][NEGATIVE] No, no, it's not.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Let's see, and you said your name is [PII].
[AGENT][NEUTRAL] Yes, [PII]
[CUSTOMER][NEUTRAL] OK, and then can I get a reference number for our call [PII]?
[AGENT][NEUTRAL] Yeah, reference number would just be my first name, last initial, and today's date. Uh so my last initial is [PII] and then was there anything else I could help you with?
[CUSTOMER][NEUTRAL] Um, not at this time.
[AGENT][POSITIVE] OK, sounds good. Well, thanks for giving us a call. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] Uh huh you too.
[AGENT][POSITIVE] Thank you bye bye.
[CUSTOMER][NEUTRAL] Mhm bye bye.