AccountId: 011433970860
ContactId: b0bb24dd-cb2d-40da-b819-4fb1a8d24f58
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 215300 ms
Total Talk Time (AGENT): 109297 ms
Total Talk Time (CUSTOMER): 88668 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/b0bb24dd-cb2d-40da-b819-4fb1a8d24f58_20250620T22:04_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Outbound sea.
[CUSTOMER][NEUTRAL] Hi, yes, uh, my name is [PII] and I'm calling with, uh, Doctor [PII]'s office. Wanted to see if I verify benefits, uh, on a patient.
[AGENT][POSITIVE] Sure, I can just benefits for you. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it's area code [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then do you have that policy number?
[CUSTOMER][NEUTRAL] Yes, you get your policy number.
[CUSTOMER][NEUTRAL] 263.
[CUSTOMER][NEUTRAL] 4871. I'm sorry, 026.
[CUSTOMER][NEGATIVE] It's 02634871. I can't even read my own handwriting.
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] Alright thank you alrighty and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and what was the name for the member?
[CUSTOMER][NEUTRAL] Man, uh, [PII].
[AGENT][POSITIVE] Awesome OK thank you so much for verifying all of that.
[CUSTOMER][NEUTRAL] [PII], I think it's [PII].
[AGENT][NEUTRAL] What it looks like. Alrighty, so this policy is active. The effective date was [PII], and this is a, uh, excuse me, it's a limited indemnity medical plan, so pays a set dollar amount per covered procedure or office visit. If you'll give me one moment, I will get those benefits pulled up.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, alright, so is there any, uh, in that, is there any like in-network out of network, or is it just because it's a limited benefit benefit alright.
[AGENT][NEUTRAL] All right. And
[AGENT][NEGATIVE] Oh, no, no, no.
[AGENT][NEUTRAL] Right, it's just pay an identity amount there's no network affiliation at at all um.
[CUSTOMER][NEUTRAL] Oh OK, OK.
[AGENT][NEUTRAL] Alright, and of course I will let you know verification of coverage is not a guarantee payment for claims. So this benefit, um, or these benefits, they have a hospital admission benefit, hospital consignment benefit, uh, accident and sickness surgical benefits, and diagnostic testing benefits, and that is going to be the extent for this policy.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] OK, so we, we, she, he would come in for office visit primary care.
[AGENT][NEUTRAL] Uh, no, office visits are not going to be covered under this policy.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Oh, OK. So he would have to go maybe to a hospital, maybe you can use those benefits. Um, what about urgent care? Is there any benefits for urgent care?
[AGENT][NEUTRAL] Let's see, not that I can see, this one seems
[CUSTOMER][NEGATIVE] That accidental.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, no, those benefits I read were going to be the expense of his coverage.
[CUSTOMER][NEUTRAL] OK, so you said uh.
[CUSTOMER][NEUTRAL] OK, extensive. OK. And then the accidental and then hospital.
[AGENT][NEUTRAL] Correct. Um, so accident and sickness surgical benefit and then pretty much hospital confinement and then diagnostic testing. Uh, and that's gonna be like, um, medical imaging test.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh OK. So what about the accidental slash sickness? What kind of, is that like, well just only when he's sick or?
[AGENT][NEUTRAL] Those are surgical benefits.
[AGENT][NEUTRAL] Accident and sur uh sickness surgical benefits, yes.
[CUSTOMER][NEUTRAL] Oh, surgical. OK. All right.
[CUSTOMER][POSITIVE] OK. All right. I'll call him and let him know. Thank you very much for your help.
[AGENT][NEUTRAL] Of course is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, ma'am, you have a good day.
[AGENT][POSITIVE] All right, you too. Thank you. Bye bye.
[CUSTOMER][POSITIVE] Thank you.