AccountId: 011433970860
ContactId: b9ad2f90-beab-4e40-85be-75e5b6aa55c0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 302089 ms
Total Talk Time (AGENT): 124736 ms
Total Talk Time (CUSTOMER): 86155 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/b9ad2f90-beab-4e40-85be-75e5b6aa55c0_20250514T14:54_UTC.wav
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[AGENT][NEUTRAL] Morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from Tampa General. I was calling to verify members' benefits.
[AGENT][NEUTRAL] OK. Sure, I can assist you with benefits and I'm sorry, I didn't quite catch your name. Can you repeat your name?
[CUSTOMER][NEUTRAL] Yes, my name is [PII]. It's spelled [PII]
[AGENT][NEUTRAL] Thank you, Ms. [PII]. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Thank you. May I have the patient's policy number on your account?
[CUSTOMER][NEUTRAL] Um, yes, the patient's policy number is 021-99746 M as in Mary, L as in Lima and the number 8.
[AGENT][NEUTRAL] Thank you. And may I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yes, it's [PII] and it's [PII].
[AGENT][POSITIVE] OK, perfect. Thank you. And what type of service is being rendered for benefits, Mr. [PII]?
[CUSTOMER][NEUTRAL] Um, yes, the patient is having an at-home sleep study.
[AGENT][NEUTRAL] OK, um, let's see what we have on the benefits.
[AGENT][NEUTRAL] And before I give you any benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer. It's gonna be a minute. I need to pull the certificate and see if at home it's gonna be covered.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Still searching, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so it doesn't look like this one have uh home benefits. It's gonna be outpatient, like outpatient facility, hospital, um.
[AGENT][NEUTRAL] Office, uh.
[AGENT][NEGATIVE] It doesn't have anything for at home.
[AGENT][NEUTRAL] Or in home.
[CUSTOMER][NEUTRAL] OK. So, OK, so she does the sleep study at home, there's no coverage. Um, but if she does it at an outpatient hospital facility, there will be coverage?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Correct. If she do it in an outpatient facility, as long as the primary insurance apply um the amount towards the deductible co-payment and co-insurance, we will consider the benefits under the outpatient benefit.
[CUSTOMER][NEUTRAL] OK, um, OK, and technically she's doing this outpatient. OK, so what would be the benefits for that just in case she asks.
[AGENT][NEUTRAL] OK, and this is not a guarantee of payment, just a verification of coverage. The outpatient maximum is 1000 per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK, that's the uh out of pocket max?
[AGENT][NEUTRAL] That's the outpatient maximum. We are the secondary, so she has a maximum of 1000 per calendar year to help with the deductibles, co-payment, and co-insurance from the major medical.
[CUSTOMER][NEUTRAL] Oh, OK. So she has another insurance primary?
[AGENT][NEUTRAL] Oh yes, mhm, mhm.
[CUSTOMER][NEUTRAL] Oh, I didn't know that. OK, I would have to call the patient cause I don't see that here.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Do you need the name? I have the name, but I'm not gonna have the number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, yes.
[AGENT][NEUTRAL] OK, so let me see. All right, so here we go. Let me go to.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so it looks like she's using Humana as her major medical.
[CUSTOMER][NEUTRAL] OK, Humana. OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] And then, OK. All right, perfect. I will follow up with them and see what is our coverage.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK. Is there anything else I may help you with today?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] OK. Well, thank you for calling ATO. Have a good day, Ms. [PII].
[CUSTOMER][NEUTRAL] You too. Mm bye-bye.
[AGENT][POSITIVE] Thank you. Bye bye.