AccountId: 011433970860
ContactId: bb961651-5253-47ca-8f5f-6e0cfeabb639
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 211100 ms
Total Talk Time (AGENT): 107464 ms
Total Talk Time (CUSTOMER): 78363 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/bb961651-5253-47ca-8f5f-6e0cfeabb639_20250619T13:31_UTC.wav
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[AGENT][NEUTRAL] Contracting ATO. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, um, my name is [PII]. I'm with the provider's office and I'm just trying to verify if the plan is still active for a member, um, and I'm not sure, uh, what area I need to be speaking with.
[AGENT][NEUTRAL] No, you're in the right area, um, and you said [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, I'm sorry. I'm just having a little trouble with my phone. [PII], I can certainly help with eligibility. What is that policy number, please?
[CUSTOMER][NEUTRAL] I have 02503347.
[AGENT][NEUTRAL] Thank you and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII], date of birth [PII].
[AGENT][NEUTRAL] Thank you. Is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] [PII] excuse me, [PII].
[AGENT][NEUTRAL] Thank you. The policy went into effect on [PII]. It is active. This is a secondary or gap insurance, um, that is meant to complement our major medical. Is there anything else at all that I can tell you about this insurance besides eligibility?
[CUSTOMER][NEUTRAL] Uh, no, uh, so it picks up after the primary.
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][NEUTRAL] OK, um, is there, uh, any type of limitations or anything that it does not cover?
[AGENT][NEUTRAL] Uh, yes, let's look over that. So the policy, um, picks up the deductible co-payment of coinsurance for in and out of hospital settings, cancer treatments, uh, independent labs, durable medical treatments or procedures within the physician's office.
[AGENT][NEUTRAL] But not the office visit co-pay. So the office visit co-pay is really the thing that is not gonna be uh uh.
[AGENT][POSITIVE] On this policy, it, it covers most anything else that is actually interesting.
[CUSTOMER][NEUTRAL] I'm sorry, I didn't understand that so it doesn't cover the office visit co-pay, but it covers the office visit itself.
[AGENT][NEUTRAL] It covers the treatments, right? It covers the treatment or procedures within the physician's office. So let's just say you had to have an ultrasound or labs or draw blood. That stuff is covered, but the office visits itself, the office visit co-pays, the, the, uh, thing that you charge us for being in the office, that is not covered.
[CUSTOMER][NEUTRAL] Just not the co-pay?
[CUSTOMER][NEUTRAL] OK, but the treatment itself is?
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][NEUTRAL] OK. OK. OK. And then is there a, a limit on the plan?
[AGENT][NEUTRAL] Yes, no, that's fine.
[CUSTOMER][NEUTRAL] As to how much it covers.
[AGENT][NEUTRAL] How much coverage is, um, so for that sort of service, what we will do is we will pick up the deductible, co-pay our coin insurance up to $2000 per calendar year. That is just a verification of the benefits, not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, 2000 per year. Alright, that is all I need. Can I, what was your name again?
[AGENT][NEUTRAL] My name is [PII]. The first letter of my last name is [PII], and we will use that in today's date is the.
[CUSTOMER][POSITIVE] And today's date as the reference. OK, thank you so much for your help, [PII]. I appreciate it.
[AGENT][POSITIVE] OK, thanks for contacting us.