AccountId: 011433970860
ContactId: ac7e920d-78e2-4474-a818-d533242e2d8d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 178100 ms
Total Talk Time (AGENT): 80955 ms
Total Talk Time (CUSTOMER): 88704 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/ac7e920d-78e2-4474-a818-d533242e2d8d_20250211T20:03_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]. I'm calling from Doctor [PII]'s office. Just calling to see what you guys cover for this patient as far as being the gap insurance.
[AGENT][NEUTRAL] OK, we're just needing to check benefits.
[CUSTOMER][NEUTRAL] Yeah, please.
[AGENT][NEUTRAL] OK, uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] OK, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] I do. The policy number is oh well I said 6081. Let me just make sure I'm gonna look at the card. I just can't be that small.
[CUSTOMER][NEUTRAL] Uh, OK, outpatient benefits number is 01.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 335-660 M as in Mary, L as in Larry, the number 8.
[AGENT][NEUTRAL] OK, thank you. And then uh what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] One second, let me close this. OK, it's [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that [PII]. Uh, so the policy is active. Effective date was [PII].
[AGENT][NEUTRAL] And this is a secondary medical policy, so it is designed to help with co-pay, deductible and co-insurance after major medical pays.
[AGENT][NEUTRAL] And of course I will let you know verification of coverage is not a guarantee of payment for claims um and this was for outpatient correct?
[CUSTOMER][NEUTRAL] Yeah, for surgery done in the specialist office.
[AGENT][NEUTRAL] OK, so their outpatient benefit is on a per calendar day basis, so it is $200 max per calendar day.
[CUSTOMER][NEUTRAL] Oh, so let's say he had surgery on [PII], whatever, he got, you guys will only cover up to $200 that day.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, this plan is a bit different. It's the outpatient benefit is per no yearly maximum. It's simply a daily maximum.
[CUSTOMER][NEUTRAL] Oh wow, OK, so daily max of 200.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK, that's not, I don't pay a lot more then. Alright, um, can I have your, so there's no like yearly, so you can do it basically if you.
[AGENT][NEUTRAL] No, the
[AGENT][NEUTRAL] Mhm there's a yearly max for the inpatient but outpatient is simply a daily maximum.
[CUSTOMER][NEUTRAL] Go ahead sorry.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Got it. OK, and it's 200, no matter what procedure it is, right?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Correct, that is just simply outpatient per day.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Alright, um, perfect. Can I have your name please and the reference number for this call?
[AGENT][NEUTRAL] Yeah, reference number would just be my first name, last initial, and today's date. Uh so my name is spelled [PII] Was there anything else I could help you with, [PII]?
[CUSTOMER][POSITIVE] No, that's all thank you so much for your help have a wonderful rest of your day.
[AGENT][POSITIVE] OK, yeah, thanks for calling APL you too bye bye.
[CUSTOMER][NEUTRAL] OK bye.