AccountId: 011433970860
ContactId: 9151cdbd-dfa7-44cb-bd4f-555a2290c866
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 163389 ms
Total Talk Time (AGENT): 75274 ms
Total Talk Time (CUSTOMER): 57019 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.7, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/9151cdbd-dfa7-44cb-bd4f-555a2290c866_20250422T12:15_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, yeah, how are you? Good morning. My name is [PII]. I'm calling you from Marymount Pediatrics to check if this member have a benefits for co-payment and deductibles.
[AGENT][NEUTRAL] I'm sure [PII], I can assist you with benefits. Um first, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. It is [PII].
[AGENT][NEUTRAL] Thank you. Now, could I get the policy number, please?
[CUSTOMER][NEUTRAL] would be 02443504.
[CUSTOMER][NEUTRAL] And [PII].
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, thank you and just let me advise you that verification of coverage does not guarantee payment of claims. The effective date on this policy was [PII]. The policy is still active.
[AGENT][NEUTRAL] Um, and is this for inpatient or outpatient benefits or an office visit?
[CUSTOMER][NEUTRAL] Uh, outpatient office visit, yeah, we are a PCP for this member.
[AGENT][NEUTRAL] OK, let's see.
[CUSTOMER][NEUTRAL] The, mhm.
[AGENT][NEUTRAL] OK, I'm showing that under this policy for office visits, um we cover up to 6000 per calendar year and that's for the co-insurance and the deductible after the primary insurance processes the claim, but the co-pay for the office visit is not covered.
[CUSTOMER][NEUTRAL] OK, the insurance covers 66,000, you say, co-payment and co-insurance.
[AGENT][NEUTRAL] Yes.
[AGENT][NEGATIVE] No, coinsurance and deductible.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But the copay for the office.
[CUSTOMER][NEGATIVE] But no co-payment.
[AGENT][NEGATIVE] Right, it's not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much. Can I get the reference number for this call?
[AGENT][NEUTRAL] Yes, ma'am. So the reference number, you can use my name and today's date. My name is [PII] um it's spelled [PII] Last initial [PII] and today's date. Is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] Uh no, that's all I need. Thank you, I see.
[AGENT][NEUTRAL] You're welcome, [PII]. Thank you for calling APL. Mm bye.
[CUSTOMER][NEUTRAL] Bye bye.