AccountId: 011433970860
ContactId: 76f0f641-c762-499f-a631-078fbaa9cb72
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 241380 ms
Total Talk Time (AGENT): 84693 ms
Total Talk Time (CUSTOMER): 69446 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/76f0f641-c762-499f-a631-078fbaa9cb72_20250415T17:50_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], good afternoon. My name is [PII]. I'm calling from, um, Doctor [PII]'s office, and I do have a patient that has this insurance. I would like to check eligibility. Uh, I don't know how this works this is a.
[CUSTOMER][NEUTRAL] Uh, kind of get a breakdown of benefits.
[AGENT][POSITIVE] OK, [PII], Happy to help. What's the patient's policy number?
[CUSTOMER][NEUTRAL] OK, policy number is 02586655.
[AGENT][NEUTRAL] All right. And do you have a good callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you so much. What is the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you. So the patient is active. The effective date on this is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We are the members secondary insurance, so this will cover deductible, co-pay, co-insurance, the primary does not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So everything that they.
[CUSTOMER][NEUTRAL] The deductible, the copay on any procedure that the insurance doesn't pay, you will cover it.
[AGENT][NEUTRAL] Right, co-pay, co-insurance and deductible, they do have a limit on the outpatient and inpatient. The outpatient benefit amount for the calendar year. Let me get that for you.
[CUSTOMER][NEUTRAL] When you say outpatient it means like out of network patients?
[CUSTOMER][NEUTRAL] I don't network provider?
[AGENT][NEUTRAL] No. Outpatient means like um doctor's office visit, an urgent care. Inpatient would be considered like in a hospital for 18 consecutive hours. Outpatient would be medical services that were not considered inpatient.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, yes, because we are a dental office.
[AGENT][NEUTRAL] Oh, you're a dental office.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, let me check one thing here, one moment.
[AGENT][NEUTRAL] Cause this isn't a dental plan, so I don't know if it's gonna cover anything for dental services.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, dental and vision services are not covered under this member's secondary plan, so this wouldn't unfortunately apply.
[CUSTOMER][POSITIVE] OK, OK, I'll let the patient know thank you so much for your help.
[AGENT][POSITIVE] You're welcome. Have a good day, [PII].
[CUSTOMER][POSITIVE] You too take care bye bye.
[AGENT][NEUTRAL] Bye.