AccountId: 011433970860
ContactId: 7ba0a552-1a1e-4c7a-901b-f01ed1cf3016
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 379250 ms
Total Talk Time (AGENT): 176372 ms
Total Talk Time (CUSTOMER): 270048 ms
Interruptions: 16
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/7ba0a552-1a1e-4c7a-901b-f01ed1cf3016_20250115T21:02_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. This is. How may I help you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, hi, I'm calling from a doctor's office. We're just trying to verify the patient's, um, gap insurance or supplement insurance to see if it does in fact cover his deductible for surgery.
[AGENT][POSITIVE] OK, I can help you with the benefits. Can I please get your name and your callback number?
[CUSTOMER][NEUTRAL] Yes, [PII], phone number [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] No name on it.
[AGENT][NEUTRAL] Thank you, [PII]. And what is the patient's name?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and what's [PII]'s date of birth?
[CUSTOMER][NEUTRAL] Say that again.
[AGENT][NEUTRAL] His date of birth?
[CUSTOMER][NEUTRAL] All right. What's date of birth? [PII].
[AGENT][NEUTRAL] Thank you. And then what is his policy number, please?
[CUSTOMER][NEUTRAL] 1800.
[CUSTOMER][NEUTRAL] 63. Policy number for the gap insurance it is 2505727.
[AGENT][NEUTRAL] OK, let me pull in that policy for you real quick.
[CUSTOMER][NEUTRAL] Form, so that phone number is not a phone number [PII], that is a fax number.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and I do see that [PII] does have an active policy. His effective date is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you're correct, this is a gap insurance that helps with deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I'm gonna try and put this in the fax like as a fax number. I'm gonna change it to any search.
[AGENT][NEUTRAL] He has an inpatient benefit amount of $7900 per calendar year and then he also has an outpatient benefit of $2500 per calendar year.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] I'm gonna seek out, but sometimes it's been very picky and I have to take out the. And when you say outpatient benefit of 2500, that includes the surgeon, correct?
[AGENT][NEUTRAL] Let me check on his policy. I'm gonna pull it up to see if surgery is actually covered under this policy. Now, will it be in a
[CUSTOMER][NEUTRAL] CVS cameras, when you Google the phone number?
[CUSTOMER][NEUTRAL] OK. And what insurance is the?
[CUSTOMER][POSITIVE] Correct because I know sometimes.
[AGENT][NEUTRAL] Will it be in an ER urgent care center or an ambulatory center? Do you know what kind of center it's in?
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] This will be done
[CUSTOMER][NEUTRAL] Yes, this will be done in an ambulatory surgery center.
[AGENT][NEUTRAL] OK, yes, it is covered under ambulatory, um, but let me see if surgery specifically is listed on his policy.
[CUSTOMER][NEUTRAL] Yeah, for you to see Caremark, yeah, we're trying to.
[CUSTOMER][NEUTRAL] Yeah, this, this. Right, because I know sometimes these gap insurances will cover the ambulatory surgery center up to 2500, but does it cover the claim for the surgeon, the, the physician?
[AGENT][NEUTRAL] For the physician, it only covers for deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] Yeah, it's a new service so.
[CUSTOMER][NEUTRAL] Yeah, is it you want, I'm assuming he wants both. So, so, but for the surgeon, right? Because two people bill. The surgery center will bill the insurance and the and the surgeon. Will it cover just the, the surgery center or will it cover the surgeon as well? For the deductible.
[AGENT][NEUTRAL] Is the surgeon billing for deductible?
[CUSTOMER][POSITIVE] It's awesome.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Or is it the surgery center?
[CUSTOMER][NEUTRAL] Both are gonna go.
[AGENT][NEUTRAL] OK, let me check as far as.
[CUSTOMER][NEUTRAL] Because the surgery center is gonna bill for their side for the facility, and then the surgeon's gonna bill for the surgeon.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, let me look and see.
[CUSTOMER][NEGATIVE] And I'm about tired right now. I am. So I was gonna say, uh, that's impatient. She's, they're bringing her back in to restart the whole process to the cataracts. She's supposed to have surgery last [PII]. Something happened, got canceled. She got sidetracked and now she wants even a new cat ball. and but she only goes to plantation.
[CUSTOMER][NEUTRAL] And I know who did she see? Would you love of course.
[AGENT][NEUTRAL] It's gonna be just a second. I'm reading need to see for sure.
[CUSTOMER][NEUTRAL] He's [PII] on [PII] that great and then just make sure we uh.
[CUSTOMER][NEUTRAL] Um uh no, confirm her information since the next year. Oh yeah, her, her, I already did it. OK, beautiful. Thank you. Oh, she has an appointment on [PII]. That's an annual.
[AGENT][NEUTRAL] So, the policy only covers for accident or sickness.
[CUSTOMER][NEUTRAL] OK, we can. OK, we can cancel that one for now and we're for sure she needs a cataract. Yeah, cause she actually she was coming in to do a back home. Got it. And then that nothing transpired from it, yeah, that's the reason why I guess they transfer her back to me because I get to the surgery first, whatever. Yeah, yeah, got it. OK. Accident or sickness and doesn't confirm.
[AGENT][NEUTRAL] So it does not say.
[AGENT][NEUTRAL] It just says um incurred by a covered person because of accident or sickness for necessary treatment services and supplies recommended by a physician but doesn't say that it'll cover the physician just for accident or sickness.
[AGENT][NEUTRAL] It does say.
[AGENT][NEUTRAL] It does say um this is what it says for physician covered charges, um, incurred by a covered person because of accident or sickness for necessary treatment services and supplies recommended by the physician incurred in a physician's office.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] from.
[CUSTOMER][NEUTRAL] No Ocular inclusion. That's the reocular exclusion of.
[AGENT][NEUTRAL] Incurred while insured under the certificate subject to any extension of benefits and is not listed on the exclusions um.
[CUSTOMER][NEUTRAL] Blockage in the blood vessel, yes. OK. Mhm. What's the insurance cost? Oh yeah. Yeah, the [PII] they have openings. I got it. Thank you. You're welcome. Oh, it doesn't include physician office.
[AGENT][NEGATIVE] It does not include charges for durable medical equipment, cancer, physical therapy, or physician's office.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] So office visits aren't covered. It, it would be for ER urgent care center, MRI imaging center or an ambulatory center.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Got it. All right, well, that, that, that I'll notate it. All right, very good. I really appreciate you looking into that for me, um, and then just so.
[AGENT][POSITIVE] It's no problem.
[CUSTOMER][NEUTRAL] Uh, a reference number if you can for the call.
[AGENT][NEUTRAL] Yes, ma'am. You can use my name. It's [PII] and today's date.
[CUSTOMER][NEUTRAL] I'm not asking you to.
[CUSTOMER][NEUTRAL] Never.
[CUSTOMER][POSITIVE] Very good. Thank you so much, [PII], for your help.
[AGENT][POSITIVE] You're welcome, [PII]. I hope you have a great day and thank you for calling APL.
[CUSTOMER][POSITIVE] Bye. Same to you. Thank you. Bye.
[AGENT][NEUTRAL] Mm, bye-bye.