AccountId: 011433970860
ContactId: 75957bdb-a95d-4458-9f43-1d31f7dbc689
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 269130 ms
Total Talk Time (AGENT): 139907 ms
Total Talk Time (CUSTOMER): 80954 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/25/75957bdb-a95d-4458-9f43-1d31f7dbc689_20250325T17:13_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I'm calling to um verify a member's eligibility and benefit please.
[AGENT][NEUTRAL] Sure, I can check eligibility and benefits for you. uh, what was your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And do you have the policy number?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] 02331430
[AGENT][NEUTRAL] OK, and uh what was the name and date of birth for the patient, please?
[CUSTOMER][NEUTRAL] Um, [PII] Hellback.
[CUSTOMER][NEGATIVE] And bear with me. I should have been more prepared.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that. Uh, so this policy is active. Effective date was [PII], and this is a secondary medical policy, so it is designed to help with co-pay, deductible and co-insurance after major medical pays, and we we needing to look at, uh, inpatient or outpatient benefits?
[CUSTOMER][NEUTRAL] Um, outpatient for a specialist office.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Office visit? OK, and of course I will let you know verification of coverage is not a guarantee of payment for claims.
[AGENT][NEUTRAL] So their outpatient benefit is on a per calendar year basis um office visits are not going to be covered under this policy however treatment received in office can be, so their calendar year maximum is I'm sorry.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] Oh go ahead. I was gonna say I might have not where I, I'm specifically looking for infertility benefits if that would change what you're saying.
[AGENT][NEUTRAL] I see in a physician's in a physician's office environment correct?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so yeah, the, the visits themselves are not going to be covered so if it was something like a consultation, um, there would be no payable benefits. However, uh, if treatment is received in office, then that could be covered under the outpatient benefit, um, that annual maximum is $1500 and if you'll give me one moment, I'll see if any of that has been used.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, she has used a bed. Give me just a minute.
[AGENT][NEUTRAL] OK, so for this year she has used $914.55.
[CUSTOMER][NEUTRAL] And it's 1500.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, so just I just wanna make sure that I understand it, so this is a secondary, so we would send it to her major medical. You guys would then be billed or be sent to you after that and then she has coverage for treatment up to $1500 minus the 91455.
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] That's correct.
[AGENT][NEUTRAL] That's correct, yes, so the visits themselves are not covered. Treatment is, um, and yes, so once she hits that 1500 maximum we would be unable to pay anything additional until the next calendar year, but we would need that, uh, explanation of benefits from the primary insurance, uh, to follow these claims or to process the claims.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] I think that's covering everything. What was your name again?
[AGENT][NEUTRAL] [PII] I know it's a bit confusing. Did you have any other questions for me, [PII]?
[CUSTOMER][NEUTRAL] I don't think so. Is there a reference number in case we do need to.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, yeah, it would just be my first name, last initial and today's date, uh, so my last initial is A.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] All right, thank you [PII].
[AGENT][POSITIVE] Alright, you are very welcome thanks for giving us a call have a great rest of your day.
[CUSTOMER][NEUTRAL] Alright you too bye.
[AGENT][POSITIVE] Thank you. Bye bye.