AccountId: 011433970860
ContactId: 79371a54-e8e0-4244-9839-411b1710293e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 386160 ms
Total Talk Time (AGENT): 172924 ms
Total Talk Time (CUSTOMER): 146416 ms
Interruptions: 3
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/21/79371a54-e8e0-4244-9839-411b1710293e_20250321T19:57_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hi, good afternoon. My name is [PII]. I'm calling from Doctor [PII]'s office. I'm calling because, uh, I wanna see if, uh, our provider participates in this insurance.
[CUSTOMER][NEUTRAL] And find out what type of plan this is.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] OK, sure network information and plan type.
[AGENT][NEUTRAL] OK, sure. I can assist you with that. And may I have a callback number just in case we get disconnected, Mr. [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] May I have the patient's policy number?
[CUSTOMER][NEUTRAL] Uh yeah, 025.
[CUSTOMER][NEUTRAL] 95546.
[AGENT][NEUTRAL] All right. And what's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] A [PII] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] All right. And let's see. So this one is one of our limited hospital indemnity plan. Um, with this one, if the provider participates with multi-plan, they get that additional discount, but it is not required because we're not contracted.
[CUSTOMER][POSITIVE] Good
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] And again, this is a a limited hospital indemnity plan.
[CUSTOMER][NEUTRAL] Oh no, Doctor [PII].
[CUSTOMER][NEUTRAL] Eminent Hospital.
[CUSTOMER][NEUTRAL] Uh, it doesn't cover office visits.
[AGENT][NEUTRAL] Um, let me give you the benefits, and this is not a guarantee of payment, just a verification of coverage, and that's just a disclaimer. Um, we do cover office visit. The office visit is covered at $50 per visit, maximum 4 visits per covered person per calendar year.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Can I give you our MPI to see if we're even in network?
[AGENT][NEUTRAL] There's no network.
[CUSTOMER][NEUTRAL] Oh, there's no network. OK, got it.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] You good.
[CUSTOMER][NEUTRAL] OK, uh, what's the office visits? Uh, you said it's, uh, 4 per calendar year.
[AGENT][NEUTRAL] Mhm, $50 each for per calendar year and that is a flat amount so that is the amount that we cover.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, does it require authorization or referrals?
[AGENT][NEUTRAL] No authorization or referral is not required because this is just a limited policy.
[CUSTOMER][NEUTRAL] S
[CUSTOMER][NEUTRAL] OK, uh, what about for tests done in the office like, uh, can I give you a couple CPT codes?
[AGENT][NEUTRAL] Um, is it like diagnostic testing or is it, um, regular tests?
[CUSTOMER][NEUTRAL] Uh, yeah, like diagnostic, like echocardiograms.
[AGENT][NEUTRAL] Oh, I don't think it is, is part of the benefit, um.
[AGENT][NEUTRAL] One moment, let me pull the diagnostic testing and give you the list of what is covered, which is not a lot. So let me just go ahead and get that pulled up, OK?
[CUSTOMER][NEUTRAL] No she healthcare primary is that HMO for the.
[AGENT][NEUTRAL] Yeah, I'm waiting on the information to pull up. One moment.
[CUSTOMER][POSITIVE] No problem thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] You have the authorization, but I just saw here that it expired.
[AGENT][NEUTRAL] OK. So it looks like this member has a medical imaging benefit for testing, um, but it only covers MRI, CT scan, PET scan, and thyroid intake. Um, those are the only ones that are covered under that benefit. And then there is a follow-up study test or advanced study test, um, and those are for.
[CUSTOMER][NEUTRAL] 56
[CUSTOMER][NEUTRAL] I'll have to call back sorry.
[CUSTOMER][NEUTRAL] Yeah, mhm.
[CUSTOMER][NEUTRAL] Actually sorry, sorry, I'm so sorry, yeah, it was actually extended before [PII].
[CUSTOMER][NEUTRAL] I have, yeah, I have.
[AGENT][NEUTRAL] Sleep study, PEE upper upper GI, lower GI nuclear stress test.
[CUSTOMER][NEUTRAL] It's A as in apple.
[CUSTOMER][NEUTRAL] 234
[CUSTOMER][NEUTRAL] 736-597.
[AGENT][NEGATIVE] Um, but it doesn't cover any EKG.
[CUSTOMER][NEGATIVE] So, EKG is not covered.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, uh.
[CUSTOMER][NEUTRAL] You said NST is covered, correct? Nuclear stress test?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Now then let me give you the
[CUSTOMER][NEUTRAL] And would that require, uh, I'm sorry, go ahead.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, the benefit on that one, let me give it to you because it's a little bit different.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Um, OK, and that is, uh, we only cover $25 on that one.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] What and that doesn't require prior authorization correct?
[AGENT][NEUTRAL] No, because it's just a limited policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, no problem, got it. uh, what's the first letter to your last?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] M as [PII] Mary.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, and you said uh.
[CUSTOMER][NEUTRAL] So for the office it pays $50 per visit and it's uh allowed 4 visits per calendar year. Is the patient uh responsible for co-pay or deductible?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] No, there's no co-payments, coinsurance or deductible on this one. It just pays that flat amount.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm
[CUSTOMER][POSITIVE] No problem thank you.
[AGENT][NEUTRAL] Alright, is there anything else I may help you with today? Any other questions or concerns?
[CUSTOMER][POSITIVE] No, that's it thank you.
[AGENT][POSITIVE] You're welcome and thank you for calling ATL. Have a good day, Mr. [PII].
[CUSTOMER][NEUTRAL] in
[CUSTOMER][NEUTRAL] Alright bye.
[AGENT][NEUTRAL] Bye bye.