AccountId: 011433970860
ContactId: 981b5093-9925-4e9f-a5d9-d4e489d150b7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 169800 ms
Total Talk Time (AGENT): 87198 ms
Total Talk Time (CUSTOMER): 55720 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/30/981b5093-9925-4e9f-a5d9-d4e489d150b7_20241230T16:15_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII] with Sherman Endoscopy Center. I'm trying to verify eligibility and benefits for a patient, please.
[AGENT][NEUTRAL] Yeah, I can take eligibility and benefits for you. I'm sorry, did you say your name was [PII]?
[CUSTOMER][NEUTRAL] Yes, [PII]
[AGENT][POSITIVE] Got it. OK, thank you. And then can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] OK, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Policy number is going to be 01592015.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] Uh, what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] It's for [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, um, I've got a different last name for [PII].
[CUSTOMER][NEUTRAL] I mean it could be uh [PII].
[AGENT][NEUTRAL] That's what we've got. OK, thank you for verifying that, [PII]. Uh, so the 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. And we we needing to look at outpatient benefits?
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and of course I will let you know verification of coverage is not a guarantee of payment for claims, so the outpatient benefit is on a per occurrence basis, it is $500 max per occurrence.
[CUSTOMER][NEUTRAL] So that means like.
[CUSTOMER][NEUTRAL] If the patient owes the deductible for the primary, the secondary is only picking up 500.
[AGENT][NEUTRAL] Per occurrence, that's correct, until that's met and then it can go towards, you know, co-insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] And do you guys follow um primary guidelines regarding authorizations?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Absolutely, as it is this plan is very dependent on major medical, so as long as their primary pays, uh, this one can if primary does not, this policy cannot.
[CUSTOMER][POSITIVE] OK, perfect. OK and what was your name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And the first initial of your last name?
[AGENT][NEUTRAL] It's A
[CUSTOMER][NEUTRAL] And did you have a reference number?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date. Was there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] Nope, that's it.
[AGENT][POSITIVE] OK, well thanks for calling APL. I hope you have a happy new year.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you, bye bye.