AccountId: 011433970860
ContactId: 793e6cb3-0d34-4bf8-b5e4-32715f855055
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 249789 ms
Total Talk Time (AGENT): 105399 ms
Total Talk Time (CUSTOMER): 112667 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/793e6cb3-0d34-4bf8-b5e4-32715f855055_20250224T17:03_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], good morning. I'm calling from some of the allergy and asthma Center. I wanted to check, um, one of our patients brought us your insurance card because she wants something to be covered, but I just wanna check if we are in network or if you guys will pay us the claim or how would that work? I know you guys are a supplement plan.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] It would be my pleasure to assist you. What is your name, please?
[CUSTOMER][NEUTRAL] [PII] and that is spelled [PII]
[AGENT][NEUTRAL] Thank you [PII]. What is the callback number?
[CUSTOMER][NEUTRAL] Callback number is gonna be [PII].
[AGENT][POSITIVE] Thank you. And the policy number, please?
[CUSTOMER][NEUTRAL] Policy number for Mam is gonna be Q1868791.
[AGENT][NEUTRAL] And you said, what is, well, I'm sorry, what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, patient's name is [PII].
[CUSTOMER][NEUTRAL] And then date of birth for this number is gonna be [PII].
[AGENT][NEUTRAL] All right, thank you. And I can help you with eligibility and benefits, [PII]. Now, first of all, the um the number in the queue is a 0.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Just so you know.
[CUSTOMER][POSITIVE] Oh, it looks, oh it looks like a cute sorry.
[AGENT][POSITIVE] That's all right.
[CUSTOMER][NEUTRAL] I have a line through it.
[AGENT][NEUTRAL] And her policy is active with the effective date of [PII]. Now this is a secondary policy to her primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what type of benefits are you needing?
[CUSTOMER][NEUTRAL] It's just uh it benefits for uh allergy test or, well, not allergy testing, but allergy injections and serum. I have the codes if you need them.
[AGENT][POSITIVE] So actually she does have benefits for any procedures or treatments in office.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For sickness or injury.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that is under her outpatient coverage.
[AGENT][NEUTRAL] That benefit amount is $2550 per calendar year, so we can pay toward her deductible, co-pay or co-insurance of her major medical.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] That is a verification of coverage and not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK, give me just one second so I can.
[CUSTOMER][NEUTRAL] So you would cover up to $2000 of the secondary and or you would cover up to $2000 of whatever the the cross doesn't cover and then after that would patient be responsible for anything?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well, we can only pay up to that maximum benefit amount. We don't just uh determine.
[AGENT][NEUTRAL] Patient responsibility, that would be up to the provider.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, so you cover up to 2550 per calendar year.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Calendar year OK.
[CUSTOMER][NEUTRAL] And then after that that'd be up to patients.
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] OK, and then so you guys, we are in network with you guys, right? There's I don't believe for.
[AGENT][NEUTRAL] So this policy, there's no um.
[AGENT][NEUTRAL] Network, we do follow the guidelines of the major medical.
[CUSTOMER][NEUTRAL] And the major manager, OK, so then.
[CUSTOMER][NEUTRAL] OK, that'll be it then can I just get your name again? I'm sorry.
[AGENT][NEUTRAL] It's gonna be my name and today's date, and I spell my name [PII].
[CUSTOMER][POSITIVE] OK, thank you so much I really do appreciate the help today.
[AGENT][POSITIVE] Well, it has been such a pleasure to assist you with those benefits. Thank you for calling APO Rosario, and have a wonderful day.
[CUSTOMER][POSITIVE] Yes thank you.
[AGENT][POSITIVE] Thank you. Bye-bye.