AccountId: 011433970860
ContactId: 9d5c91a6-6af7-4588-aba8-995b07c1ba87
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 207759 ms
Total Talk Time (AGENT): 83677 ms
Total Talk Time (CUSTOMER): 86619 ms
Interruptions: 0
Overall Sentiment: AGENT=1.9, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/9d5c91a6-6af7-4588-aba8-995b07c1ba87_20250124T15:46_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII]. I'm calling from the provider's office. Um, I'm calling to verify the benefits and eligibility of this plan and also to check if we're within the network.
[AGENT][POSITIVE] Um, yes, ma'am. I can assist you with benefits. Could I get your name one more time first and a good callback number?
[CUSTOMER][NEUTRAL] Yes, my name is [PII], spelled [PII] and it shows my last name is [PII].
[AGENT][POSITIVE] OK. Thank you and a good callback number in case we're disconnected.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII]. Now, could I get the policy number, please?
[CUSTOMER][NEUTRAL] Policy number 01852127 M like Mary L like Lima 8.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] OK. And just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII]. The policy is still active. And is this for inpatient or outpatient benefits or an office visit?
[CUSTOMER][NEUTRAL] Yes, we are in in specialist office visit.
[AGENT][NEUTRAL] OK. For office visits, we cover up to 7000 per calendar year and that's for the co-insurance and the deductible after the primary insurance processes the claim, but the co-pay for the office visit is not covered. And we don't go by network, um, since we are secondary insurance coverage, we go by the primary insurance guidelines.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] be.
[CUSTOMER][NEUTRAL] you
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] OK, just to make sure I have the correct information, you cover up to 7000 per calendar year, including the deductible, but the copay for the office visit is not covered.
[AGENT][NEUTRAL] That's correct. The co-insurance is covered and the deductible for office treatments, but the co-pay for the visit is not covered.
[CUSTOMER][NEUTRAL] OK, uh.
[CUSTOMER][NEUTRAL] OK, got it. The deductible as well as the coinsurance, OK, deductible.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] Per calendar year.
[CUSTOMER][POSITIVE] In cloning. OK, thank you so much. I'm sorry, what was your name again?
[AGENT][NEUTRAL] Um, it's [PII]. It's spelled [PII] and my last initial is [PII]. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] Um, can you give me a reference number for this call?
[AGENT][NEUTRAL] Yes, for the reference number, you can use my name in today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so so much for your help, Miss [PII]. I hope you have a good Friday.
[AGENT][NEUTRAL] You do the same, so. Thank you for calling APL. Mm bye.