AccountId: 011433970860
ContactId: b70a3382-102d-4eff-9e63-9c4f33e2a45b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 332880 ms
Total Talk Time (AGENT): 156094 ms
Total Talk Time (CUSTOMER): 190360 ms
Interruptions: 9
Overall Sentiment: AGENT=1.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/08/b70a3382-102d-4eff-9e63-9c4f33e2a45b_20250508T17:41_UTC.wav
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[AGENT][NEUTRAL] the
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] Oh
[AGENT][POSITIVE] Hello, thank you for contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][POSITIVE] Hello, thank you for contacting APL.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][POSITIVE] Hello, thank you for contacting ATR. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm here to verify member eligibility. Are you on speakerphone because I'm not getting your voice clearly.
[AGENT][NEUTRAL] No, uh, this is the lab, uh, this is the lob it's getting. I'm, I'm sorry I don't.
[AGENT][POSITIVE] yeah, what is the policy number that I can help with? I can certainly help with eligibility.
[CUSTOMER][NEUTRAL] I can hardly hear you. I think you are asking about the policy number and it's 0197.
[AGENT][NEUTRAL] OK, yes.
[AGENT][NEUTRAL] 0
[CUSTOMER][NEUTRAL] 01972960
[AGENT][NEUTRAL] OK, thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Thank you. Is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] [PII] direct line.
[AGENT][NEUTRAL] OK, thank you. The policy went into effect on [PII] and it is active. Is there anything else I can tell you about the secondary or gap insurance?
[CUSTOMER][NEUTRAL] OK, thank you. The policy went into effect on the [PII] and it is active.
[CUSTOMER][NEUTRAL] I can
[CUSTOMER][NEUTRAL] Yes. What will it, will it cover the primary insurance patients responsibility like deductible, co-insurance, and co-pay?
[AGENT][NEUTRAL] Yes, what it does is that it picks up the deductible, co-payment or co-insurance for in and out of hospital settings as well as um the office visit co-pay.
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] Uh, is there anything in particular that I could tell you about the policy?
[CUSTOMER][NEUTRAL] Is there
[CUSTOMER][NEUTRAL] So, deductible, co-pay and co-insurance are covered if services are going to be performed in office.
[AGENT][NEUTRAL] Uh, yeah, well, yes, the, the office visit, if it's for a physician's office, the office visit co-pay is paid. Um, there's 4 office visit co-pays that are, that are covered at $25 each, and that's just a verification the benefits not a guarantee of payment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] the office.
[CUSTOMER][NEUTRAL] Um, the 4 office visit copays that are that are covered at $25 a week and that's just a verification of the benefits, not again into the payment.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK. And will it cover the radiology?
[AGENT][NEUTRAL] Uh, well, it would go under that, um, that, uh.
[CUSTOMER][NEUTRAL] Uh well it would go under that um that uh.
[AGENT][NEUTRAL] The outpatients, if it's if it's in an outpatients office, uh, I mean facility, or if it's in the physician's office, it could be covered under that $25 office visit co-pay.
[CUSTOMER][NEUTRAL] The outpatient, if it if it's in an outpatient office I mean facility or if it's in the physician's office, it can be covered under that $25 copay. OK, so it depends on where.
[AGENT][NEUTRAL] So it just depends on where it is performed.
[CUSTOMER][NEUTRAL] So there is a $25 copy, right?
[AGENT][NEUTRAL] That's right, yes, for the office building.
[CUSTOMER][NEUTRAL] What office is it that's right.
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] OK, OK. Is this plan has any deductible and out of pocket maximum?
[AGENT][NEUTRAL] Uh, the, um, for the out of, uh, pocket for the office visit.
[CUSTOMER][NEUTRAL] But the um the out of uh pocket for the offices.
[AGENT][NEUTRAL] It's um it's at 4 office visits per calendar year. Uh, there's no, there's no additional um out of pocket unless it's over that $25 and uh for outpatient hospital it's $500 per occasion and again all of these figures are just a a verification, not a guarantee of payment and anything above that would be, would be.
[CUSTOMER][NEUTRAL] It's um it's at 4 office visits per calendar year. Uh, there's no, there's no additional uh out of pocket and then it goes at $25.
[CUSTOMER][NEUTRAL] Uh, and, uh, for outpatient hospital it's $500 per occasion and again all of these figures are just a verification, not a.
[CUSTOMER][NEUTRAL] And anything above that would be.
[AGENT][NEGATIVE] Something that would not be covered with it for the policy.
[CUSTOMER][NEUTRAL] For, for outpatient services, there is a $500.
[AGENT][NEUTRAL] Yes, per occasion.
[CUSTOMER][NEUTRAL] We
[AGENT][NEUTRAL] Uh, no, not a co-pay. That's the, that's the benefit. Otherwise, it, yeah, there's no, there's no co-pays other than that. I mean there's no co-pay.
[CUSTOMER][NEUTRAL] OK, so this, OK, that means plan will cover up to $500 for outpatient.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] So this is
[CUSTOMER][POSITIVE] That's correct. OK.
[AGENT][POSITIVE] That, that's correct.
[CUSTOMER][NEUTRAL] OK. And the $25 is this patient responsibility or this is covered by the plan?
[AGENT][NEUTRAL] That is, that is what is covered by the plan.
[CUSTOMER][NEUTRAL] OK. $25 is covered by the plan for office visit and outpatient services is covered at up to $500.
[AGENT][POSITIVE] That's, that is correct.
[CUSTOMER][NEUTRAL] OK. And out of 4 visits, how much has been used by the patient?
[AGENT][NEUTRAL] Uh, for this calendar year, no, none of the visits have been used yet.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is there any limit for the outpatient services like numbers of visits?
[AGENT][NEUTRAL] No, no, there isn't.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else that
[CUSTOMER][POSITIVE] Thank you. Could you please provide me your name and I
[AGENT][NEUTRAL] Yes, uh my name is [PII].
[CUSTOMER][NEUTRAL] No, that's all for today and now.
[AGENT][NEUTRAL] Certainly. My name is [PII]. Yes, [PII] is [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Why
[CUSTOMER][NEUTRAL] Alright
[AGENT][NEUTRAL] And the first letter of my last name is [PII].
[AGENT][NEUTRAL] And we're gonna use that today's date as our reference.
[CUSTOMER][POSITIVE] OK, [PII]. Thank you.
[AGENT][POSITIVE] OK, thank you for contacting ATL