AccountId: 011433970860
ContactId: 8c167130-b6f5-4b30-b15a-47e09d95eb56
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 181000 ms
Total Talk Time (AGENT): 97822 ms
Total Talk Time (CUSTOMER): 95928 ms
Interruptions: 4
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/8c167130-b6f5-4b30-b15a-47e09d95eb56_20250320T15:44_UTC.wav
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[AGENT][NEUTRAL] Contacting ATL, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, hey, um, good morning, good afternoon. I'm calling to check, uh, benefits for a patient, not a.
[AGENT][POSITIVE] I can help with benefits.
[AGENT][NEUTRAL] Yeah, and with whom am I speaking, please?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] [PII], thank you. And um what is that policy number that we're looking at today, [PII]?
[CUSTOMER][NEUTRAL] Uh, the name or the member ID?
[AGENT][NEUTRAL] Well, yes, uh, it should begin with a 01 or 02.
[CUSTOMER][NEUTRAL] And you this uh.
[CUSTOMER][NEUTRAL] Yeah, yeah, 02584178 M as in mother.
[CUSTOMER][NEUTRAL] L as in Larry
[CUSTOMER][NEUTRAL] 8
[AGENT][NEUTRAL] Thank you, and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Yeah, uh, password
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And her date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I appreciate that. The policy went into effect on [PII]. I'm sorry, I forgot to ask you. I do need a callback number please in the event that we're disconnected.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. Um, again, the policy went into effect on [PII]. It is active. Now, you mentioned benefits. This is a secondary or gap insurance that has in and out of hospital benefits only. So for the inpatient hospital, uh, that's 18 hours or more in a hospital setting.
[AGENT][NEUTRAL] We'll pick up the deductible, co-payment or co-insurance from their major medical up to $6750 for services within an outpatient hospitals.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Uh, 700, 50 you said?
[AGENT][POSITIVE] 6750. That's correct.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] And for a
[CUSTOMER][NEUTRAL] And and that includes professional services that includes professional services.
[AGENT][NEUTRAL] Uh, no, no, it does not. It's just in and out of hospital settings and that's just a verification of the benefits, not a guarantee of payment. So it's really just hospital settings that this, this policy takes care of. So if you're in a physician's office, then there's no benefits, yeah, it, it doesn't cover any of that, [PII]'s, it's just for hospital.
[CUSTOMER][NEUTRAL] Because
[CUSTOMER][NEUTRAL] Quite a
[CUSTOMER][NEUTRAL] Yes, oh, no benefits for office and for professional services. So if I give you a service code, could you please check the benefits for that? No, 5, um, 545 I'm sorry 59,400.
[AGENT][NEUTRAL] No, sir.
[AGENT][NEUTRAL] Uh, certainly. What is the code?
[AGENT][NEUTRAL] OK, so, um,
[CUSTOMER][POSITIVE] Yeah, no, this is the, the, the doctor's office, so we're gonna build by, by the doctor's office and not by the facility. Very good, thank you very much for your assistance.
[AGENT][NEUTRAL] That's, uh, if you're in a physician's office, then that's not covered. If you're in the hospital, then it, uh, um, it would be covered.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, well, there's nothing I can help with. Thanks for contacting AP have