AccountId: 011433970860
ContactId: 927ee11f-eeac-429d-a745-dd1959ff7ce4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 261570 ms
Total Talk Time (AGENT): 112818 ms
Total Talk Time (CUSTOMER): 111339 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/927ee11f-eeac-429d-a745-dd1959ff7ce4_20250408T18:50_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] calling from Doctor [PII]'s office calling to see if the patient's still active with this insurance also if it's cover, um.
[CUSTOMER][NEUTRAL] Specialist um procedure in the office?
[AGENT][POSITIVE] Um, yes, ma'am. I can assist you with benefits. Um, first, could I please get your name again and a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII], and that's [PII].
[CUSTOMER][NEUTRAL] OK, so it's your first name last name.
[AGENT][NEUTRAL] Thank you, [PII]. Now I need the policy number, please?
[CUSTOMER][NEUTRAL] 02610045
[CUSTOMER][NEUTRAL] Sorry, 2001
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII] [PII], first name [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] and the policy is still active and for services done in office, let's see.
[AGENT][NEUTRAL] We cover up to 5500 per calendar year, and that's for the coinsurance and the deductible after the primary insurance processes the claim, but the co-pay for the office visit is not covered.
[CUSTOMER][NEUTRAL] OK, so, so you only cover the co-insurance and the deductible?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, not copay?
[AGENT][NEUTRAL] Not the co-pay, not uh for services done in the office.
[AGENT][NEUTRAL] But for any other outpatient services, um, the co-pay is included. For example, any outpatient services done in the hospital.
[AGENT][NEUTRAL] Or outpatient surgery center or urgent care facility.
[AGENT][NEUTRAL] But in office.
[CUSTOMER][NEUTRAL] Oh, so this is
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, so this is only for um outpatient hospital.
[AGENT][NEUTRAL] Right. Um, the co-pay, the co-insurance and deductible is for outpatient hospitals, but for office visits, we only cover the co-insurance and the deductible. The copay is not covered for office visits.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] OK, so hold on let me write this down, OK, um.
[CUSTOMER][NEGATIVE] Copay, no, no.
[CUSTOMER][NEUTRAL] Co-insurance and deductible.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Cover
[CUSTOMER][NEUTRAL] Oh, outpatient.
[CUSTOMER][NEUTRAL] Facility.
[CUSTOMER][NEUTRAL] And what what do you cover for the office visit?
[AGENT][NEUTRAL] For the office, we only cover the co-insurance and the deductible, but not the co-pay.
[CUSTOMER][NEUTRAL] Car insurance.
[CUSTOMER][NEGATIVE] And they also uh not copay.
[AGENT][NEUTRAL] Right, for office visits.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] For office visit even even specialist.
[AGENT][NEUTRAL] Right from specialist.
[CUSTOMER][NEUTRAL] Like an OBG one.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, for the hospital you guys cover the co-insurance.
[CUSTOMER][NEUTRAL] And the deductible.
[AGENT][NEUTRAL] And the co-pay.
[CUSTOMER][NEUTRAL] For outpatient
[CUSTOMER][NEUTRAL] And copay.
[AGENT][NEUTRAL] Right, for outpatient. Yes, ma'am.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Outpatient services and then in the office it's only co-insurance and deductible.
[AGENT][POSITIVE] Yes, ma'am. That's correct.
[CUSTOMER][NEGATIVE] Not the co-payment.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, and can I have your name please and a reference number?
[AGENT][NEUTRAL] Yes, for the reference number, you can use my name and today's date. My name is [PII], um it's spelled [PII] My last initial is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you so much [PII] have a nice day.
[AGENT][NEUTRAL] Is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] OK. I thank you again for calling APL. You have a great rest of your day as well. Mm, bye.
[CUSTOMER][NEUTRAL] You too bye.