AccountId: 011433970860
ContactId: ad52715e-b3c9-4d66-86a7-88ddadc9ad15
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 198399 ms
Total Talk Time (AGENT): 86506 ms
Total Talk Time (CUSTOMER): 77026 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/ad52715e-b3c9-4d66-86a7-88ddadc9ad15_20250407T22:51_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]. This is [PII] with Doctor [PII]'s office at Desert Hematology oncology, and I am calling to verify eligibility and benefits for a patient.
[AGENT][NEUTRAL] OK, I'm happy to check on benefits and eligibility today, [PII]. What's the patient's policy number?
[CUSTOMER][NEUTRAL] 01851715
[AGENT][NEUTRAL] OK, let me pull that up and then do you have a good callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that. Patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII] [PII].
[AGENT][NEUTRAL] All right, so patient is active. Effective date on this is [PII]. We are the members secondary insurance, so this will cover deductible, co-pay, co-insurance, the primary does not.
[CUSTOMER][NEUTRAL] OK, and do you follow pre-certification guidelines for Aetna or do certain things require pre-cert through you anyway?
[AGENT][NEUTRAL] No pre-cert is required. Uh, there is a limit, of course, on the benefits. Do you need outpatient, inpatient?
[CUSTOMER][NEUTRAL] Um, he's coming in for specialist office. Let me see what his diagnosis is or if we even have it in the chart yet.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, it just says he's got abnormal labs, so I'm not sure if they'll be looking at doing genetic testing or what they'll be looking at doing at this point.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I guess worst case scenario if they do genetic testing, is that something that's covered or or what's the guidelines on that?
[AGENT][NEUTRAL] So yeah, usually we'll follow the primary since we're the secondary, the gap insurance, so their primary has to pay for us to pick up anything.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Um, the outpatient benefit limit on the plan is, let me pull that up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So their outpatient benefit max for the calendar year, it looks like it's $2000.
[AGENT][NEUTRAL] And patient is 2500.
[AGENT][NEUTRAL] And patients defined as being, of course, in the hospital for at least 18 hours consecutively.
[CUSTOMER][NEUTRAL] OK, so you said for the outpatient limit the max per calendar year is $2000 so if they exceed that $2000 in outpatient office visits or treatment of any kind, then they're responsible for the remainder.
[AGENT][POSITIVE] Correct, yes. Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So anything above patient responsibility.
[CUSTOMER][NEUTRAL] OK perfect and can I get a call reference number?
[AGENT][NEUTRAL] Yeah, absolutely. Call reference is my name with my last initial, then today's date. My name again is [PII], which is [PII] Last name is [PII], and then today's date.
[CUSTOMER][POSITIVE] Perfect, thank you so much.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.