AccountId: 011433970860
ContactId: af0e17de-cb1e-4c43-a205-56dae530036c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 255820 ms
Total Talk Time (AGENT): 127415 ms
Total Talk Time (CUSTOMER): 142692 ms
Interruptions: 6
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/af0e17de-cb1e-4c43-a205-56dae530036c_20250326T17:46_UTC.wav
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[AGENT][POSITIVE] Thank you for contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][POSITIVE] Alright thank you.
[CUSTOMER][NEUTRAL] Hi [PII], good afternoon. My name is [PII]. I'm calling from a facility and I'm just trying to verify this um member's benefits for an upcoming procedure here.
[AGENT][NEUTRAL] Yes, I can help with that, [PII]. This is the policy number, please?
[CUSTOMER][POSITIVE] Um, I have it. I hope it's correct. It is.
[CUSTOMER][NEUTRAL] It's 02.
[CUSTOMER][NEUTRAL] 304196. M as in Mary, L as in love, B as in boy.
[CUSTOMER][NEUTRAL] Then I have um two additional letters, a dash V as in Victor, G as in girl.
[CUSTOMER][POSITIVE] I know that's correct.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII], date of birth.
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK, I just need a callback number please in the event that we're disconnected.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The policy went into effect on [PII].
[CUSTOMER][NEUTRAL] To get
[AGENT][NEUTRAL] Um, it is active. Now, the policy has, uh, in and out of hospital benefits. So it's not for a, uh, a physician's office. Um, the hospital benefits, the outpatient hospital benefits will pick up the deductible, co-payment or co-insurance for a major medical up to $1500 for inpatient services, that is, uh, being in the hospital for 18 hours or more.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Correct, because of the.
[CUSTOMER][NEUTRAL] So, but it has
[CUSTOMER][NEUTRAL] Because even so we still need the insurance to come back.
[CUSTOMER][NEUTRAL] I acknowledge and.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] We'll also pick up the deductible, co-payment or co-insurance up to $1500. Now, that's just a verification, the benefits, not a guarantee of payment, and it doesn't look like any of the benefits have been used for the calendar year [PII], but it is just for hospital services.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Uh, it's very
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] This was still [PII].
[CUSTOMER][NEUTRAL] OK, so we're, we're a facility, so we're an outpatient, um, ambulatory surgical center. Does that
[AGENT][NEUTRAL] Yes, that, that's what we would, that's uh one of the things that is covered.
[CUSTOMER][NEUTRAL] OK, just wanted to make sure because we're not hospital based but that's fine. I just wanted to make sure.
[AGENT][NEUTRAL] Oh, that's fine.
[CUSTOMER][NEUTRAL] OK perfect and you said your name was [PII], right?
[AGENT][POSITIVE] Yes, my name is [PII]. We're gonna use my name and today's date as a reference. Is there anything else at all I can help with?
[CUSTOMER][NEUTRAL] With
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, [PII], um, as far as like when we do process the claim, I wanna make sure we have the correct, um, claims address. Um, I have a [PII].
[AGENT][NEUTRAL] Uh, no, we're, uh, we are actually based out of, uh, [PII]. So our mailing address is [PII], yes, I'm sorry, yes. It's [PII].
[CUSTOMER][NEUTRAL] As you know, as it is your right to there's not a way to.
[CUSTOMER][NEUTRAL] OK, claims address yeah.
[CUSTOMER][NEUTRAL] So that people try to try to, you know, your detention that will also reflect on the.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] That is in [PII].
[CUSTOMER][NEUTRAL] And you want there.
[AGENT][NEUTRAL] Our zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, you can also fax the claim.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] Yes, our, our zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Or you can fax the claim to us.
[AGENT][NEUTRAL] At 877.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 9423 or probably the fastest way would be to use our online service center at [PII].
[CUSTOMER][NEUTRAL] Because what
[CUSTOMER][NEUTRAL] If you're
[CUSTOMER][NEUTRAL] That's never
[CUSTOMER][NEUTRAL] Here
[AGENT][NEUTRAL] So it's um we do have a uh online service center that you could send that to as well.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK [PII], thank you so much for your help. I appreciate it. Um, I'm sorry, [PII], right, nope, that's it. Thank you.
[AGENT][NEUTRAL] OK, there's, yes ma'am.
[AGENT][NEUTRAL] Anything else at all?
[AGENT][POSITIVE] OK, thanks for contacting ATL. Have a very good day.
[CUSTOMER][NEUTRAL] When