AccountId: 011433970860
ContactId: b24b0777-f650-4539-9d93-c02457d5a413
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 138300 ms
Total Talk Time (AGENT): 84577 ms
Total Talk Time (CUSTOMER): 44987 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/b24b0777-f650-4539-9d93-c02457d5a413_20250318T19:36_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I'm just calling to see what kind of benefits this plan is for this patient.
[AGENT][POSITIVE] Yes, ma'am. I can assist you with benefits. Um, first, could I get your name and a good callback number?
[CUSTOMER][NEUTRAL] [PII] callback number [PII].
[AGENT][NEUTRAL] OK, thank you, [PII]. Now, could I get the policy number, please?
[CUSTOMER][NEUTRAL] It is going to be um 02573216.
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII], date of birth [PII].
[AGENT][NEUTRAL] OK. Thank you and just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII]. The policy is still active, and this is a policy for secondary gap insurance. What we do is cover the co-pay, the co-insurance, and the deductible for coverage services, um, after the primary insurance processes the claim. Um, what type of service is this for?
[CUSTOMER][NEUTRAL] It's outpatient surgery.
[AGENT][NEUTRAL] OK. Will it take place at an outpatient hospital or in the office?
[CUSTOMER][NEUTRAL] Um, at an ambulatory surgery center.
[AGENT][NEUTRAL] OK. Yes, ma'am. That is covered um for outpatient services, we cover up to 1000 per calendar year. And again, that's for the co-pay, the co-insurance, and the deductible after the primary insurance processes the claim.
[CUSTOMER][NEUTRAL] OK and then do um does the office send you the claim or does the patient or the member?
[AGENT][NEUTRAL] Um, the office sends the, sends the claim along with the EOB from the primary insurance company. Now, the patient can send the claim if um the provider doesn't send it in, but most, normally the provider sends the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect. All right.
[CUSTOMER][POSITIVE] I appreciate your help on this thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] OK. Well, I thank you again, [PII], for calling ATL. You have a great rest of your day. Mm bye.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Mm, thank you.