AccountId: 011433970860
ContactId: c4c84cf8-3155-4812-91b9-42131bf8ec0f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 327220 ms
Total Talk Time (AGENT): 151937 ms
Total Talk Time (CUSTOMER): 153587 ms
Interruptions: 4
Overall Sentiment: AGENT=1.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/c4c84cf8-3155-4812-91b9-42131bf8ec0f_20250424T14:04_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], thank you. This is [PII] from Unique Imaging. I need to verify members gap benefits please for a co-pay he's being charged for.
[AGENT][NEUTRAL] OK, [PII], you're needing to verify eligibility and benefits or only benefits?
[CUSTOMER][NEUTRAL] Say it again.
[CUSTOMER][NEUTRAL] Say it again.
[AGENT][NEUTRAL] Do you need to verify only, ma'am, only benefits or eligibility and benefits?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, both eligibility and benefits.
[AGENT][POSITIVE] OK, yes ma'am. I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] OK hold on
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] The member's policy number, please, [PII].
[CUSTOMER][NEUTRAL] Yes, it's 02270639.
[AGENT][NEUTRAL] OK, thank you. One moment while I get the member's information pulled up.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] you.
[AGENT][NEUTRAL] And any information that I do provide for you today, [PII] would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] not that.
[CUSTOMER][NEUTRAL] It's uh [PII] [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Uh, uh, uh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, she'll go with that.
[AGENT][NEUTRAL] OK, so I do show that he is the subscriberal policy and it is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what type of benefit information again are you needing for him inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK, so it's outpatient. We're a diagnostic center, not the hospital, but we're a diagnostic center, and he's being charged a $300 copay by his primary insurance.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, one moment for me to get the outpatient benefits pulled up.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] OK thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] She's gonna pull the doctor's office.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] And what was your name again?
[CUSTOMER][POSITIVE] Thank you honey bye bye.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] OK, so the outpatient benefit maximum is $750 per covered person per calendar year for covered outpatient services and there is no outpatient.
[AGENT][NEUTRAL] Deductible per covered person per calendar year, but
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Oh, I lost you. I'm sorry.
[CUSTOMER][NEGATIVE] I lost you there. You said patient has no deductible?
[AGENT][NEUTRAL] No deductible on the supplemental policy, and the outpatient benefit maximum is $750 per covered person per calendar year for covered outpatient service.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Got it. OK. And do those benefits still appear available?
[AGENT][NEUTRAL] For
[CUSTOMER][NEUTRAL] As of today?
[AGENT][NEUTRAL] [PII], yes, ma'am. They do.
[AGENT][NEUTRAL] And because this policy [PII] is a supplemental policy to his primary insurance when the claim is
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Submitted to us for review, we will have to have a of the primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] Mhm, OK.
[AGENT][NEUTRAL] And then once we have
[AGENT][NEUTRAL] Process our claim we do have a portal in which you should be able to check claim status.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that website for the portal is located at [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] OK, great, [PII]. I'll just need a reference number for today's benefits and that'll be all.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am, you would use my name on.
[AGENT][NEUTRAL] Along with today's date.
[CUSTOMER][NEUTRAL] You say
[AGENT][NEUTRAL] So if that didn't help you with today my name in today's date.
[CUSTOMER][NEUTRAL] OK, I'm sorry, I missed the initials of your last name.
[AGENT][NEUTRAL] S
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Oh, [PII]. Got it. OK, [PII]. Thank you. Have a great day.
[AGENT][POSITIVE] OK. Well, yes, ma'am, you too, and thank you again for calling APL if that is all I can help you with.
[CUSTOMER][NEUTRAL] Yes bye bye.
[AGENT][NEUTRAL] All right, [PII]. Bye-bye.