AccountId: 011433970860
ContactId: 9b75a1fd-2922-48cb-9840-9391fd5f0211
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 180880 ms
Total Talk Time (AGENT): 107107 ms
Total Talk Time (CUSTOMER): 92204 ms
Interruptions: 5
Overall Sentiment: AGENT=0.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/9b75a1fd-2922-48cb-9840-9391fd5f0211_20250414T16:34_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], good afternoon. My name is [PII] and I'm calling from a provider's office. I'm calling to get the benefits and the eligibility for a member.
[AGENT][NEUTRAL] Sure, I can check eligibility benefits for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then did you have that policy number?
[CUSTOMER][NEUTRAL] Uh yes, 02502521.
[AGENT][NEUTRAL] OK, and what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] [PII] [PII] or the insured I'm sorry, it's probably, oh, do you see her? Oh OK.
[AGENT][POSITIVE] Perfect, thank you for verifying that.
[AGENT][NEUTRAL] No, that's OK. um, yes, yes, um, is is she who you're going to be seeing?
[CUSTOMER][NEUTRAL] Yes, no, yeah, when you called in March like.
[AGENT][NEUTRAL] OK, yeah, so I do see her thank you. um, 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, and we'll be needing to look at, uh, inpatient or outpatient benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No wor
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] It's for outpatient rehab services.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, of course I will let you know verification of coverage is not a guarantee of payment for claims. Uh, so the outpatient benefit is $2500 max for, um, per calendar year. If you'll give me one moment, I'll see if any of that has been used.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so [PII] has used $160 of that benefit so far this year.
[CUSTOMER][NEUTRAL] OK, and that's out of pocket?
[AGENT][NEUTRAL] Um, that's the total benefit amount that we would pay per calendar year. Yeah, this plan doesn't have any, um, uh, deductibles or anything like that.
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, so question, if a patient has a $60 co-pay under her primary, what would, uh, would it cover? Would her secondary cover that $60 or no?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's what this policy is designed to help with is co-pay, deductible and co-insurance up to that $2500 limit uh per calendar year.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so it will, it's pretty much it's gonna cover whatever that copay is.
[AGENT][POSITIVE] Yeah, up, up to that limit, correct.
[CUSTOMER][NEUTRAL] Up until 2500, OK.
[CUSTOMER][NEUTRAL] Got it. OK, um, OK. Can I get a reference number, please?
[AGENT][NEUTRAL] Sure, reference number would just be my first name, last initial, and today's date. Um so my name is spelled [PII] last [PII] is [PII] Was there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] OK, you said in today's date 4-14-25?
[AGENT][NEUTRAL] Right.
[CUSTOMER][POSITIVE] OK, alright, perfect, thank you [PII] that's it alright have a good one you too bye bye.
[AGENT][POSITIVE] Alright, yeah, thanks for calling APL. Have a great rest of your day. You too, bye bye.