AccountId: 011433970860
ContactId: a414f842-a1c3-42ce-ac7e-f13d2ff906ea
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 170160 ms
Total Talk Time (AGENT): 98708 ms
Total Talk Time (CUSTOMER): 63467 ms
Interruptions: 0
Overall Sentiment: AGENT=2.2, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/a414f842-a1c3-42ce-ac7e-f13d2ff906ea_20250407T12:28_UTC.wav
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[AGENT][NEUTRAL] For contacting ATM. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Hi, yes, good morning. I'm sorry you said your name was [PII]?
[AGENT][POSITIVE] That's correct, yes. How can I help you?
[CUSTOMER][NEUTRAL] Hi, hi, yes, [PII], my name is [PII] and I'm calling to verify patients benefits, please.
[AGENT][POSITIVE] A certainly help with benefits. What's that policy number we're looking at today?
[CUSTOMER][NEUTRAL] That is 1070635.
[AGENT][NEUTRAL] Thank you, and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Um, [PII] [PII].
[AGENT][NEUTRAL] Thank you. Is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Yes ma'am, [PII].
[AGENT][NEUTRAL] Thank you. Um, well, first of all, the policy, uh, this is a group, um, secondary or gap insurance, and whenever they renew as a group, they always get a new policy number. So the, the newest policy number.
[AGENT][NEUTRAL] It went into effect on [PII] is 01.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] 842158. Again, that, that went into effect on [PII]. It is active. Now, the benefits for the secondary or gap insurance. It takes up the deductible, co-payment, or co-insurance for in and out of hospital, uh, services, uh, treatment within the physician's office, uh, cancer treatment, that sort of thing. So for outpatient benefits, we'll pick up the deductible, co-payment, or co-insurance up to $500 per calendar day.
[CUSTOMER][NEUTRAL] OK, that's
[AGENT][NEUTRAL] Or for inpatient um hospital stays of 18 hours or more, it's $5000 per calendar year. Now, this is just a verification of those benefits, not a guarantee of payment, but that's what the policy uh does.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, so just make sure I understand it, uh, this policy covers deductible, co-pays and co-insurance for, um, this is gonna be outpatient surgery. So for outpatient surgery, up to $500 per day.
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][NEUTRAL] OK, and you said the policy number is 018421558?
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][NEUTRAL] I know
[CUSTOMER][NEUTRAL] And do you, does this plan cover for DME durable medical equipment?
[AGENT][NEUTRAL] Uh, let's see. I'm not really sure. Let me just check. Um,
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Yes, it does. So that would be under the outpatient benefit of $500 per calendar day.
[CUSTOMER][NEUTRAL] OK, so it covers the DNA as well, up to $500 and this is a shared benefit between the facility and the surgeon?
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][POSITIVE] Awesome, I appreciate that. [PII], may I have a reference number for today's call?
[AGENT][NEUTRAL] Yes, my name is [PII]. The first letter [PII] [PII], and we're gonna use that in today's date as a reference. Is there anything else at all that I may help with?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] No, that would be it. I appreciate all your help.
[AGENT][POSITIVE] OK, well, thank you for contacting HTL. I hope you have a very good day. Thank you.
[CUSTOMER][POSITIVE] You as well thank you.