AccountId: 011433970860
ContactId: 949af9c0-ac8d-4a90-b64b-d268a9872dd8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 261920 ms
Total Talk Time (AGENT): 123173 ms
Total Talk Time (CUSTOMER): 99016 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/949af9c0-ac8d-4a90-b64b-d268a9872dd8_20250127T17:33_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from Doctor [PII]'s office calling to get benefits for a patient, please.
[AGENT][POSITIVE] OK, Ms. [PII], I can help you with benefits.
[AGENT][NEUTRAL] And you said that was Dr. [PII]'s office?
[CUSTOMER][NEUTRAL] [PII]'s office, yes.
[AGENT][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] Thank you and then what is your uh callback number, Ms. [PII] just in case the call is disconnected?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And what is the patient's name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is [PII]'s date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And his policy number, please?
[CUSTOMER][NEUTRAL] Um, it is 02144097 M like Mary, L like Larry, the number 8.
[AGENT][POSITIVE] OK, thank you. I'm gonna pull that policy in for us.
[AGENT][NEUTRAL] OK, I do show that [PII] does have an active policy. His effective date is [PII].
[AGENT][NEUTRAL] And this is just um to verify his coverage it's not a guarantee of payment he has a supplemental policy that is billed secondary to the primary.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] To get insurance helps with deductible copay and co-insurance.
[CUSTOMER][NEGATIVE] I'm sorry we're breaking up something terrible.
[CUSTOMER][NEUTRAL] Are you still there?
[AGENT][NEUTRAL] It's a gap insurance that, yes, I'm still here.
[CUSTOMER][NEGATIVE] OK, it was breaking up. I was only getting every other word.
[AGENT][NEGATIVE] It's a gap
[AGENT][POSITIVE] Oh my. Oh, I'm so sorry. Yes, it's, it's a gap insurance that helps with deductible, co-pay and co-insurance.
[CUSTOMER][NEUTRAL] There you go.
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] Uh huh
[AGENT][NEUTRAL] He has an inpatient benefit amount of $5000 per calendar year and an outpatient benefit amount of $5000 per calendar year.
[CUSTOMER][NEUTRAL] So how does that work?
[AGENT][NEUTRAL] So the um primary insurance is billed first and we're billed second and that benefit amount helps with deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] OK, so you'll pay with the, so he has a $5000 benefit, um, does he need pre-certification for anything?
[AGENT][NEUTRAL] No, ma'am, because it's, this is not the primary insurance.
[CUSTOMER][NEUTRAL] OK, OK, so you'll pay up to $5000?
[AGENT][NEUTRAL] Yeah, deductible, co-pay, or co-insurance.
[AGENT][NEUTRAL] Are you still there?
[CUSTOMER][NEUTRAL] Yes ma'am, I'm just writing this down and this is only for at a like at a hospital correct? not for office visits for specialists?
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Let me check his policy to see if it covers office visits.
[CUSTOMER][NEUTRAL] Or like for his patient responsibility to the physician does it cover that or does the outpatient meeting only towards the facility? I guess I need to clarify.
[AGENT][NEUTRAL] Let me
[AGENT][NEUTRAL] Right, it's for facility, it's by facility.
[CUSTOMER][NEUTRAL] It's for the facility only, not for an office, OK, the physician's fees.
[AGENT][NEUTRAL] Right, that's correct, and it only covers for deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, but OK, so it's facility only whatever his patient responsibility is there, not for the physician fees.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, because it says outpatient benefit, but you know what I mean, because he has a $5000 deductible and part of those 5 part of that $5000 is gonna go to the doctor and then part of it's gonna go to the facility.
[AGENT][NEUTRAL] Right, I understand what you're saying.
[CUSTOMER][NEUTRAL] OK, alright, so it's towards the facility only and um is there a reference number or anything for this call?
[AGENT][NEUTRAL] Yes ma'am, you can use my name. It's [PII] in today's date.
[CUSTOMER][POSITIVE] OK, thank you so much.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] Thank you. I hope you have a good day, Ms. [PII]. Thanks for calling APL.
[CUSTOMER][NEUTRAL] You too.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Bye.