AccountId: 011433970860
ContactId: 7d833798-88c5-46c1-8f4f-bc67cdd69a21
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 363329 ms
Total Talk Time (AGENT): 133792 ms
Total Talk Time (CUSTOMER): 69541 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=1.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/7d833798-88c5-46c1-8f4f-bc67cdd69a21_20250102T15:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, yes, I'm calling for benefits and eligibility please of one of our patients.
[AGENT][NEUTRAL] OK, I can help you with benefits and eligibility. Can I please get your name and your callback number?
[CUSTOMER][NEUTRAL] Oh yes, of course. It's gonna be [PII].
[CUSTOMER][NEUTRAL] And the callback number is [PII].
[AGENT][NEUTRAL] Thank you, [PII]. What is the patient's name?
[CUSTOMER][NEUTRAL] And the patient's name is gonna be for [PII].
[CUSTOMER][NEUTRAL] The date of birth, would you need that as well?
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK, and then what is [PII]'s, um, policy number, please?
[CUSTOMER][NEUTRAL] 01629106 M as in Mike L as in Lima 8.
[AGENT][NEUTRAL] OK, alright, let me pull the policy up for you real quick.
[AGENT][NEUTRAL] OK, I see that that is it [PII] has an active policy. Her effective date is [PII].
[AGENT][NEUTRAL] And this is just to verify benefits, it's not a guarantee of payment. This is a supplemental insurance policy that's secondary to the primary. It helps with deductible, co-pay and co-insurance.
[AGENT][NEUTRAL] And she has an inpatient benefit amount of $1500 per calendar year.
[CUSTOMER][NEUTRAL] It's
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It's gonna be for a specialist in a specialist office. So does it cover office visit and um office procedure?
[AGENT][NEUTRAL] Let me um let me pull up her policy real quick to see if she has um coverage for specialist.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] Give me just a sec while the computer pulls it in.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're very welcome.
[AGENT][NEUTRAL] OK. I do show that she does have an office treatment writer on this policy.
[AGENT][NEUTRAL] So she can go to a physician's office?
[AGENT][NEUTRAL] And it is covered on this policy.
[CUSTOMER][NEUTRAL] OK, so it's
[CUSTOMER][POSITIVE] So it's, OK, so it's covered, perfect.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, and it covers up to how much?
[AGENT][NEUTRAL] Let me look and see, it says on the um physician's office treatment benefit we will pay the out of pocket amount for physician cover charges. So it depends on what the charge is, um, what the procedure code is on what it'll pay.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] But it does help with deductible, co-pay and co-insurance. Yes.
[CUSTOMER][NEUTRAL] OK, and the outpatient.
[CUSTOMER][NEUTRAL] OK, and the outpatient surgery?
[AGENT][NEUTRAL] Let me look and see.
[CUSTOMER][NEUTRAL] And the plan pays up to how much?
[AGENT][NEUTRAL] Let me find for surgery real quick.
[CUSTOMER][NEUTRAL] So it's an in office procedure.
[AGENT][NEUTRAL] OK, it covers up to.
[AGENT][NEUTRAL] Depending on the procedure code.
[AGENT][NEUTRAL] It covers up to $1500 per calendar year.
[CUSTOMER][NEUTRAL] And how much has been accumulated?
[AGENT][NEUTRAL] Let me look and see.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Nothing has been accumulated for the year of [PII].
[CUSTOMER][POSITIVE] OK, perfect. All right, that's all that I needed and a reference number?
[AGENT][NEUTRAL] Yes, ma'am. You can use my name. It's [PII], and today's date.
[CUSTOMER][POSITIVE] Thank you so much, [PII]. You have a great day and hope you have a had a great New Year.
[AGENT][POSITIVE] You too, [PII]. I hope you do too. Thank you so much. I appreciate that. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][POSITIVE] You're welcome.