AccountId: 011433970860
ContactId: af13bffa-7137-47f3-a6c1-87020c13a63c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 542479 ms
Total Talk Time (AGENT): 185710 ms
Total Talk Time (CUSTOMER): 216386 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/2025/05/20/af13bffa-7137-47f3-a6c1-87020c13a63c_20250520T19:44_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good afternoon, [PII]. Can you help me verify eligibility and benefits for a patient?
[AGENT][NEUTRAL] Mhm. Happy to check on eligibility and benefits. What is the patient policy number?
[CUSTOMER][NEUTRAL] I have a D.
[CUSTOMER][NEUTRAL] 49,700.
[CUSTOMER][NEUTRAL] 004.
[AGENT][NEUTRAL] OK. Unfortunately, we can't look the member up with that number. Do you have their card? Do you see like a certificate number on it?
[CUSTOMER][NEUTRAL] No, she she just provide me this number over the phone.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, I don't have the image of the insurance ID card.
[AGENT][NEUTRAL] Yeah, we'll have to look her up. Do you have name or social? We can look them up that way.
[CUSTOMER][NEUTRAL] Um, I have her name, but I'm not sure if I have her Social Security on file. Give me one second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, other than Social Security and name, um, what is the other, um, information that I can that we can look her up by?
[AGENT][NEUTRAL] I would have to have name um and name or social, one of the two. It doesn't have to be both, just either or.
[CUSTOMER][NEUTRAL] OK, her first name is [PII]
[CUSTOMER][NEUTRAL] Last name is [PII]
[AGENT][NEUTRAL] OK, let me try by that.
[AGENT][NEUTRAL] Do they live in [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. What is their date of birth?
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. Uh, so the patient does have an active medical plan. Would you like the policy number?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Uh, policy number is gonna be 02.
[AGENT][NEUTRAL] 62.
[AGENT][NEUTRAL] 1990.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so, uh, just to make sure her.
[CUSTOMER][NEUTRAL] Policy number is 02621990, is that correct?
[AGENT][POSITIVE] Mhm mhm. Correct.
[CUSTOMER][NEUTRAL] Does, does she have like a group number for this one or just a policy number?
[AGENT][NEUTRAL] Let me see what the group number is.
[AGENT][NEUTRAL] Group number on this is going to be 70101.
[CUSTOMER][NEUTRAL] 70101.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK and um what is the effective date of this plan?
[AGENT][NEUTRAL] Effective date is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and um which network that this uh policy use which provider network?
[AGENT][NEUTRAL] So, it's a limited benefit plan. Um, so it's just going to pay a set amount depending upon what the patient's being seen for. Are they being seen for an office visit or?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, so it doesn't matter, uh, the provider network, it just pay out a fixed amount.
[AGENT][NEUTRAL] No, cause it's
[AGENT][NEUTRAL] Right, because it's not a major medical. It's a limited benefit plan.
[CUSTOMER][NEUTRAL] Got you. Alright, and um, so it's APL American Public line. um, can I have the claim mailing address and a payer ID number if you have?
[AGENT][NEUTRAL] Payer ID is 64556.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claims for this member's policy are actually going to um IMA Inc. So that's I as in India, M as in Mary, A as in apple, Inc.
[CUSTOMER][NEUTRAL] A I M A Inc.
[AGENT][NEUTRAL] And
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] Mhm, OK.
[AGENT][NEUTRAL] It's that [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that's in [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Alright and uh.
[CUSTOMER][NEUTRAL] May I have her um benefit for the specialist office visit, diagnostic lab?
[AGENT][NEUTRAL] Mhm, that's.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Diagnostic X-ray.
[CUSTOMER][NEUTRAL] And surgery in the office.
[AGENT][NEUTRAL] OK, so the patient's diagnostic testing benefit, uh, the plan will pay $100 for the test, and there's a maximum of 1 per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Any advance or follow up testing would pay $25.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] A surgery in a hospital, hospital outpatient facility or freestanding surgery center or surg or physician's office.
[AGENT][NEUTRAL] It looks like $500 per day, a maximum of 1 day.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] If it's in a physician's office, it's gonna pay a maximum of 250 with a maximum of 1 day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] And um.
[CUSTOMER][NEUTRAL] What about the office visit?
[AGENT][NEUTRAL] Office visit, it looks like it's gonna pay $50 per visit and they're allowed a maximum of 4 visits in a calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And um for the diagnostic testing, the any follow-up is $25 per test. Does it limit how many tests it is for the follow-up?
[AGENT][NEUTRAL] And I'll
[AGENT][NEUTRAL] Yeah, it allows one follow up it looks like.
[CUSTOMER][NEUTRAL] OK, just one follow up.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I see. Um, so the, for the outpatient surgery, it just pay a fixed amount of $500 a day. It, it, it's just a fixed amount like that, it's not dependent on the CPT code.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, I'll
[CUSTOMER][NEUTRAL] So since since is not using any network, is it the same for the hospital? Like all the hospital get paid the same amount doesn't matter in or out of network?
[AGENT][POSITIVE] Correct, yeah.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][POSITIVE] I see, thank you, sir.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then I'll just need a reference number for our call and that's it.
[AGENT][NEUTRAL] Absolutely. Call references my name with my last initial, then today's date. My name again is [PII], that's [PII] Last initial is [PII], and then today's date.
[CUSTOMER][NEUTRAL] Alright then thank you sir um one last question, does it require the authorization for the outpatient service?
[AGENT][NEUTRAL] It does not require pre-authorization, no, ma'am.
[CUSTOMER][POSITIVE] Alright, got you, thank you.
[AGENT][POSITIVE] You're welcome. Have a good rest of your day.
[CUSTOMER][POSITIVE] Thank you same to you bye now.
[AGENT][NEUTRAL] Bye-bye.