AccountId: 011433970860
ContactId: c88f3298-68d7-40e7-9fce-855b49c1f543
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 329609 ms
Total Talk Time (AGENT): 165058 ms
Total Talk Time (CUSTOMER): 133761 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/c88f3298-68d7-40e7-9fce-855b49c1f543_20250204T17:28_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII].
[AGENT][NEUTRAL] Hi.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Hey, [PII].
[CUSTOMER][NEUTRAL] I ain't ever called you before.
[AGENT][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] Well, I have a provider on the line trying to verify uh benefits on a patient and it's a, a high um hospital indemnity, but there's nobody in the queue for that. So [PII] told me to get care team.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, yeah, they're, I think the hospital indemnity calls are supposed to be rolling over to us now that's one of the news that we picked up on Monday, but yeah, what um did you get the policy number or anything or you just have the person's name or?
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] So she didn't have the policy number and I forgot to give it to her but I've got it pulled up. Policy number is 257.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] 645 3
[AGENT][NEUTRAL] OK. And do you know the lady?
[CUSTOMER][NEUTRAL] She verified the name and date of birth. Her name is [PII].
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] [PII], and do you know what uh office she's calling from?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] She said she's calling from a facility and she's calling about an outpatient tonsillectomy procedure.
[AGENT][NEUTRAL] OK, and she's just trying to get information on a claim, is that what it was?
[CUSTOMER][NEUTRAL] Yeah, I, she's just wanting to verify the benefits, um, because, um, the patient didn't have any information, didn't have the policy number I had to look it up by the social.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Oh goodness, oh good, OK, yeah, go ahead and put it through.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Alright thank you [PII] have a good day.
[AGENT][POSITIVE] You're welcome you too bye bye.
[CUSTOMER][NEUTRAL] Mhm. Bye-bye.
[AGENT][NEUTRAL] Hi [PII], this is [PII]. I'm with the care team.
[CUSTOMER][POSITIVE] Yes ma'am, how are you today?
[AGENT][NEUTRAL] I'm doing well, Ms. [PII], can you please give me the name of the facility that you're calling from?
[CUSTOMER][NEUTRAL] Yes, this is Amed Health A N M E D and Med Health.
[AGENT][POSITIVE] OK, thank you so much and you were looking for eligibility and benefits on.
[AGENT][NEUTRAL] Um, ride.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] [PII]. Yes, [PII]. That's correct.
[AGENT][POSITIVE] OK, thank you. OK. All right, thank you so much. Let me pull him up real quick.
[AGENT][NEUTRAL] Alright, I do show that he does have an active policy. His effective date is [PII].
[AGENT][NEUTRAL] And this is just to verify coverage. It's not a guarantee of payment. He has a hospital indemnity plan. It's a limited hospital plan.
[AGENT][NEUTRAL] He has a daily hospital consignment benefit of $100.
[AGENT][NEUTRAL] And he has the first.
[AGENT][NEUTRAL] Occurrence hospital confinement one time a year of $1500.
[AGENT][NEUTRAL] Uh, he has an outpatient sickness benefit that pays $75.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For sickness online.
[AGENT][POSITIVE] And he has a wellness and diagnostic benefit that pays $25.
[AGENT][NEUTRAL] And then he also has a surgery and anesthesia rider that pays $50.
[CUSTOMER][NEUTRAL] OK, now let me ask, is there a deductible?
[AGENT][NEUTRAL] No, ma'am.
[AGENT][NEGATIVE] I do not see a deductible for him.
[CUSTOMER][POSITIVE] No deductible. OK, wonderful. What about out of pocket expense?
[AGENT][NEUTRAL] I don't see out of pocket expense. It just shows his benefits that we pay.
[CUSTOMER][NEUTRAL] You do not
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] One last thing, I know you gave me the effective date of the policy. Could you give me the policy number?
[AGENT][NEUTRAL] Absolutely. The policy number is 2576453.
[CUSTOMER][NEUTRAL] Alright, 2576453. I see any other information because they do not have his card scanned into the system, but yet she has, um, I guess she has checked to make sure this code CPT code, uh, does not require prior authorization. Um, I don't know how she checked it.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] No, ma'am. It doesn't because we're not the it doesn't because we're not the major medical.
[CUSTOMER][NEUTRAL] OK. All right. Um, OK, I think that's what I need. And may I have your name?
[AGENT][NEUTRAL] Yes, ma'am. You can use, um, my name is [PII]
[AGENT][NEUTRAL] And today's date and you can use that as your reference number.
[CUSTOMER][POSITIVE] That's what I'll do. Thank you so much. I really appreciate your help.
[AGENT][POSITIVE] You're very welcome, Ms. [PII]. I'm glad we were able to um find him and give you the help that you needed.
[CUSTOMER][POSITIVE] I am so glad. Thank you so very much. I really appreciate it.
[AGENT][POSITIVE] You're welcome. You have a good day and thanks for calling APL.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] All right. Bye-bye, Ms. [PII].
[CUSTOMER][NEUTRAL] All right, bye-bye.