AccountId: 011433970860
ContactId: ab73aeaa-257f-41cd-a28e-b430ad7cf616
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 148660 ms
Total Talk Time (AGENT): 71053 ms
Total Talk Time (CUSTOMER): 58751 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/ab73aeaa-257f-41cd-a28e-b430ad7cf616_20250217T15:27_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi I was calling to find out um.
[CUSTOMER][NEUTRAL] The benefits for a member, for one of your members they're having surgery and want to see what they will cover as far as the deductible.
[AGENT][NEUTRAL] Sure we could take a look at those benefits uh this was for outpatient.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah it's an outpatient.
[AGENT][NEUTRAL] OK, got you, um, what was your name? I'm sorry?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, [PII], can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Alright, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, I do. It is 0.
[CUSTOMER][NEUTRAL] 258.
[CUSTOMER][NEUTRAL] 0209 ML 8.
[AGENT][NEUTRAL] Alright thank you and then what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that. Uh, so the policy is active. Effective date was [PII], and as this is a secondary medical policy, it is designed to help with co-pay, deductible and co-insurance after major medical pays. And of course I will let you know verification of coverage is not a guarantee of payment for claims. So the outpatient benefit is $4000 max per calendar year. If you'll give me one moment, I'll see if any of that has been used.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so let's see, $750 has been used so far this year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, thank you so much.
[AGENT][NEUTRAL] Of course is there anything else I can help you with?
[CUSTOMER][NEUTRAL] No, that'll be that's uh and as far as his um.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh my [PII]. As far as for outpatient, does, does these benefits actually cover like MRI charges?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] They do OK
[AGENT][NEUTRAL] Yes, that would fall under the diagnostic test benefit which, yes, that is a covered benefit under the outpatient.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] Of course, yeah, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you bye bye.