AccountId: 011433970860
ContactId: b1883f16-e311-43eb-8b81-5ea269ce736e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 367299 ms
Total Talk Time (AGENT): 147538 ms
Total Talk Time (CUSTOMER): 182785 ms
Interruptions: 5
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/b1883f16-e311-43eb-8b81-5ea269ce736e_20250225T17:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from the provider's office to check the patient eligibility and benefits.
[AGENT][NEUTRAL] OK, [PII], I can help you with eligibility and benefits for your patient. May I please get your callback number and the name of the facility that you're calling from?
[CUSTOMER][NEUTRAL] Sure. So the, it is, uh, I'm calling from Nicola Children's Hospital.
[CUSTOMER][NEUTRAL] And the callback number is [PII]?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Thank you, ma'am. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Sure. The patient policy number I do have is, just a moment. It is 0.
[CUSTOMER][NEUTRAL] 1659727 M as in Mike, L as in Lima, and number 8.
[AGENT][NEUTRAL] OK, the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, the patient's first name is [PII]. The last name is [PII]. It is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK, let me pull up that policy real quick for us, Miss [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Oh OK, I do show that this policy for [PII] is no longer active. It lapsed on [PII], but I'm checking to see if she does have an active policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes, I do see an active policy. Let me give you that, that active policy number.
[CUSTOMER][POSITIVE] Yes, go ahead please.
[AGENT][NEUTRAL] It's 2502796.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, it is 2502796. Am I right?
[AGENT][NEUTRAL] Yes, and the effective date for [PII] is [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And this is just to verify benefits. It's not a guarantee of payment. This is a supplemental gap insurance policy that helps with deductible, co-pay, and co-insurance.
[CUSTOMER][NEUTRAL] uh
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I'm not.
[CUSTOMER][POSITIVE] Yes I do.
[AGENT][NEUTRAL] The insured has an inpatient benefit amount per calendar year of $7900 and then she also has an outpatient calendar year benefit amount of $2500 to go towards the deductible co-pay or co-insurance.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] In
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I'm so uh I do apologize. Um, so you said that the patient is effective from [PII] and the patient has supplemental gap plan, right? Medicare supplemental gap plan.
[AGENT][NEUTRAL] Right, Medlink supplemental gap plan that helps with deductible, co-pay, and co-insurance only.
[CUSTOMER][NEGATIVE] Mhm. So the patient has only the deductible co-pay coinsurance that is not a fuck it.
[AGENT][NEUTRAL] I'm sorry, I did, can you repeat the question?
[CUSTOMER][NEUTRAL] So you said that the patient has only the deductible co-pay co-insurance, am I right?
[AGENT][NEUTRAL] Right, that's what's covered on this policy for inpatient, she has $7900 and for outpatient she has $2500 per calendar year in a covered facility.
[CUSTOMER][NEUTRAL] OK, let me
[CUSTOMER][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm. OK. And could you please check, um, what is the patient responsibility for the office visit specialist?
[AGENT][NEUTRAL] Uh, that is based on the primary insurance.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm. You mean the patient annual deductible amount.
[CUSTOMER][NEUTRAL] For outpatient, it is 2500, right?
[AGENT][POSITIVE] Yes, that's the benefit.
[CUSTOMER][NEUTRAL] Uh-huh. May I know the amount?
[AGENT][NEUTRAL] Uh, let me look and see if she's used anything.
[CUSTOMER][NEUTRAL] So the, so the remaining is 2500.
[AGENT][NEUTRAL] Let me check to see if anything's been used this year for you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] No, nothing has been used this year so that benefit is still remaining.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] So the patient does have any co-pay?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] The patient doesn't have co-pay, right? And no co-insurance as well as.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, I think I got, I got all the information. And is often referral is required for office visit?
[AGENT][NEUTRAL] I'm sorry, what did you just say?
[CUSTOMER][NEUTRAL] Uh, is all needed for office visit?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] No, because this is not the primary insurance.
[CUSTOMER][NEUTRAL] OK, thank you, and I do apologize, I didn't get your name. Could you please spell out your name, please?
[AGENT][NEUTRAL] Yes, it's [PII]
[CUSTOMER][NEUTRAL] Uh, I'm sorry, your voice is breaking. Can I get it again?
[CUSTOMER][NEUTRAL] You what?
[AGENT][NEUTRAL] Yes, it's [PII]
[CUSTOMER][NEUTRAL] OK, thank you, [PII]. And can I have the reference number for this call?
[AGENT][NEUTRAL] Yes ma'am, you can use my name and today's date.
[CUSTOMER][POSITIVE] Mhm. OK. Thank you, [PII]. Thanks for the information and have a great day. Bye-bye. Take care.
[AGENT][POSITIVE] You're very welcome. You too, Ms. [PII]. Thanks for calling APL bye bye.