AccountId: 011433970860
ContactId: 937df20d-eeab-409f-bc94-3ce86bebba72
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 295339 ms
Total Talk Time (AGENT): 122428 ms
Total Talk Time (CUSTOMER): 72260 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/937df20d-eeab-409f-bc94-3ce86bebba72_20250205T19:46_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Hi, um, good afternoon. I was calling to get eligibility and benefits for patients.
[AGENT][NEUTRAL] Yeah, I can check eligibility benefits for you. Uh, what was your name?
[CUSTOMER][NEUTRAL] Uh my name is [PII]. It's [PII]
[AGENT][NEUTRAL] OK, and Ma, can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] Yes, it's gonna be [PII].
[AGENT][NEUTRAL] Got it, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, that's gonna be 02473158, M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] OK, thank you. And uh what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] A member's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that. Uh, so this policy is active. Effective date was [PII], and this is a secondary medical policy, so it is designed to help with co-pay, deductible and co-insurance after major medical pays. Um, we really need to look at the outpatient benefits?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, yes, please.
[AGENT][NEUTRAL] OK, and of course I will let you know verification of coverage is not a guarantee of payment for claims, so their outpatient benefit is on a per calendar day basis. It is uh $300 max per calendar day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that includes um offices as well, the offices of cope.
[AGENT][NEUTRAL] Um, I don't know that office visits are covered under this policy. Give me just a moment, let me check that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Sorry, bear with me just a moment.
[CUSTOMER][POSITIVE] Mhm, no problem.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sorry about the wait. I appreciate your patience. um, so no, it does not look like office visits are covered under this policy.
[CUSTOMER][NEUTRAL] OK, so anything else that gets done, um, other than the office it would fall under that um the $300 per day.
[AGENT][NEUTRAL] Correct. Um, so that covered, um, facilities. So it'd be like a hospital emergency room, urgent care, um, surgery in an outpatient facilities, um, diagnostic time in an outpatient facility, things like that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, would it cover the if.
[CUSTOMER][NEUTRAL] Allergy testing, um, injection serum, were done in offices, I mean, like in a specialist office.
[AGENT][NEUTRAL] No, I don't have any sort of uh physician's office or specialist office, uh, any coverage for those uh facilities.
[CUSTOMER][NEUTRAL] OK, so you said it's hospital, um.
[AGENT][NEUTRAL] Mhm. So, emergency room, urgent care, uh, hospital outpatient facility, free-standing outpatient surgery centers, um, diagnostic testing and an MRI facility, or a hospital outpatient facility.
[AGENT][NEUTRAL] And then uh physical therapy facilities.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alrighty and then um if I can just go ahead and get your name one more time, the first initial to your last name and a reference number for the call.
[AGENT][NEUTRAL] Sure, so reference number would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII], and was there anything else I could help you with?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Um, no, that'll be it. Thank you so much, [PII].
[AGENT][POSITIVE] OK, yeah, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You as well bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.