AccountId: 011433970860
ContactId: 6d084293-5814-4d45-a5ff-9fc47bc12e04
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 209100 ms
Total Talk Time (AGENT): 93535 ms
Total Talk Time (CUSTOMER): 64062 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/11/6d084293-5814-4d45-a5ff-9fc47bc12e04_20250611T18:48_UTC.wav
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[AGENT][POSITIVE] Thank you for contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from Nicholas Children's Hospital to check on the eligibility and benefit for a patient.
[AGENT][NEUTRAL] Then I can help with eligibility benefits. What's the policy number, please?
[CUSTOMER][NEUTRAL] Number is 021.
[CUSTOMER][NEUTRAL] 233
[CUSTOMER][NEUTRAL] 55 M as L as in Lima 7.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Patient first name is [PII]. Last name is [PII].
[CUSTOMER][NEUTRAL] The date of birth, [PII].
[AGENT][NEUTRAL] Thank you. Is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure, I'll call one. The callback number is [PII].
[AGENT][NEUTRAL] OK, thank you. The policy went into effect on [PII]. It is active.
[AGENT][NEUTRAL] The policy, this is a secondary or gap insurance and it has both in and out of hospital benefits. Is there anything in particular that I can tell you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, yes, uh, um, may I know the copay, is there any copay or co-insurance for this plan?
[AGENT][NEUTRAL] Well, it picks up the deductible co-payment or co-insurance from their major medical for outpatient services. Now it, it includes outpatient hospital and treatment within the physician's office. It does not include the copay for the office visit. So is the benefit that you're wanting to know about is, is for a physician's office or is it for outpatient hospital?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, specialist, uh, for specialist offices.
[AGENT][NEUTRAL] OK, thank you. So the policy will pick up the deductible, co-payment or coinsurance for treatments or procedures.
[AGENT][NEUTRAL] Within a physician's office, up to $2000 per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That is just a verification of the benefits, not a guarantee of payment.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] But then it does not cover the office visit co-pay.
[AGENT][NEUTRAL] The office visit co-pay is not covered. Treatments and procedures are.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So not the office is the co-pay.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Is there anything else at all I can tell you about the secondary? Yes, uh-huh.
[CUSTOMER][NEUTRAL] Uh, is there any
[CUSTOMER][NEUTRAL] Is there any referral or authorization for this one?
[AGENT][NEUTRAL] There's, there's no, uh, pre-authorization that's required.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] Uh, well, that's all the information needed. Sorry, I didn't catch your name here. Can I get your name, please?
[AGENT][NEUTRAL] My name is
[AGENT][NEUTRAL] Yes, my name is [PII], and the first letter of my last name is [PII], and we're gonna use that.
[AGENT][NEUTRAL] And today's date for our reference.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you so much for that. Have a nice day.
[AGENT][POSITIVE] OK, thanks for contacting us. Have a good day.