AccountId: 011433970860
ContactId: 830a74ae-8b9e-494c-b40b-222b31a18e3d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 187350 ms
Total Talk Time (AGENT): 85436 ms
Total Talk Time (CUSTOMER): 158050 ms
Interruptions: 10
Overall Sentiment: AGENT=0.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/830a74ae-8b9e-494c-b40b-222b31a18e3d_20250415T17:36_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you? Yes, hi, I'm calling to verify um an insurance on a on a on a patient.
[AGENT][NEUTRAL] OK, we just need to check eligibility.
[CUSTOMER][NEUTRAL] OK. Yes, um, yes, and the main thing I'm calling to check to see, because this is a secondary insurance if it covers co-pays.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Absolutely. OK, we can get that pulled up and take a look. And what was your name?
[CUSTOMER][NEUTRAL] Office copay, yes, yes, my name is [PII].
[AGENT][NEUTRAL] OK, and can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] OK, and can I get a good call back number in case we Yes, [PII].
[AGENT][NEUTRAL] Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Thank you. And then do you have that policy number? Yes, I do. It is 023315-550.
[AGENT][NEUTRAL] OK, and what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] OK, and what was the name and date of birth for the member? It is [PII] [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that. So this policy is active effective date was [PII].
[CUSTOMER][POSITIVE] Perfect, thank you for verifying that. So this policy is active. Its effective date was [PII].
[AGENT][NEUTRAL] And you said this was for office visits, correct?
[CUSTOMER][NEUTRAL] And you said this was for office visits, correct?
[CUSTOMER][NEUTRAL] Yes, it's uh we're a specialist and they give us this as a secondary so they can cover like uh his copays.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure, OK, so of course I will let you know verification coverage is not a guarantee of payment for claims, so this policy does not cover office visits, however, treatment received in office is covered under their outpatient benefit.
[CUSTOMER][NEUTRAL] Sure, OK, so of course I will let you know verification coverage is not a guarantee of payment for claims, so this policy does not cover office visits. However, treatment received in office is covered under their outpatient benefit. The outpatient benefit is on a per calendar day basis. It pays up to $350 max per calendar day, and that does go towards co-pay, deductible and co-insurance after major medical pay. OK.
[AGENT][NEUTRAL] Their outpatient benefit is on a per calendar day basis. It pays up to $350 max per calendar day, and that does go towards co-pay, deductible and co-insurance after major medical pays.
[CUSTOMER][NEUTRAL] So my main clarification, it does not cover office copies, right?
[AGENT][NEUTRAL] Not for just visits so if they received treatment in office that could be covered, but if it was just say a consultation or something like that, that would not be covered.
[CUSTOMER][NEUTRAL] Not for just visits. So if they receive treatment in office, that could be covered, but if it was just like Yeah, you see, like if he has a, he has AMed as a primary insurance and his AM is $50.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So he wants to use the secondary to cover those $50 for his first for his insurance so it's not covered. Yes, what is you? OK, alright, correct. OK, so what is uh your name?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Office visits themselves are not covered, correct.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And um and what is the reference number for this call?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date. Uh, so my last initial is [PII] Was there anything else I can help with?
[CUSTOMER][NEUTRAL] Reference number would just be my first name, last initial, and today's date, uh so my last initial is [PII] Was there anything else to help with? What was that?
[AGENT][NEUTRAL] Was there anything else I can help you with?
[CUSTOMER][NEUTRAL] Was there anything else I can help you with? No, that'd be all.
[AGENT][POSITIVE] OK, well thanks for calling APL. I hope you have a great rest your day.
[CUSTOMER][POSITIVE] OK, well thanks for calling I hope you have a great. You too you too bye bye.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.