AccountId: 011433970860
ContactId: cb38da20-5f12-40dd-80ce-6018a3f580f3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 151419 ms
Total Talk Time (AGENT): 75918 ms
Total Talk Time (CUSTOMER): 59282 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/cb38da20-5f12-40dd-80ce-6018a3f580f3_20250217T19:33_UTC.wav
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[AGENT][NEUTRAL] contacting ATL, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Good afternoon. This is [PII]. I'm calling from Northeast Georgia physicians Group. I just wanna check on member's eligibility.
[AGENT][NEUTRAL] I can help with eligibility. What's that policy number, please?
[CUSTOMER][NEUTRAL] It's 02491680.
[AGENT][NEUTRAL] Thank you, and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] I may pronounce this wrong it's [PII].
[CUSTOMER][NEUTRAL] Date of birth is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] I appreciate that. Thank you. Is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Mhm [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you very much. The policy went into effect on [PII] and it is active. Is there anything else I can tell you about this hospital indemnity policy?
[CUSTOMER][NEUTRAL] Um, yes, I've noticed that this is, um, a limited benefit plan, so we will take it. However, I wanna know if this is like a PPO or an HMO plan.
[AGENT][NEUTRAL] No, it's, what it is, it's, it's, um, it is a limited benefit policy. That's, that's exactly the way to describe it. So, for example, if um uh there are physician's office visits, there are 2 of them throughout the calendar year, um, excuse me, 4 of them throughout the calendar year, we pay up to $50 for each one. if they, if they went to the ER we would pay $50 for the ER visit.
[AGENT][NEUTRAL] Um, that's just a verification of benefits, not a guarantee of payment, but that's what this policy does. It, it, it pays a very limited benefit for the services that, that are offered.
[CUSTOMER][NEUTRAL] OK, you said the plan only pays $50 per procedure for appointment?
[AGENT][POSITIVE] That's, that's correct.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] All right, well
[CUSTOMER][NEUTRAL] And does he have a copy or anything?
[AGENT][NEUTRAL] Uh, no, um, but anything that's over and above that $50 would be, um, that, that's our contractual obligation that would be met with that, and you'd need to talk to, uh, him about anything else that's over and above that.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] OK, I will let him know, OK, so any, even if it's preventative care like in uh physical exam, it will only cover $50.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] OK, sounds good I'll let him know.
[AGENT][NEUTRAL] Is there anything else at all I can help with?
[CUSTOMER][POSITIVE] Um, no, that should be all, thank you so much.
[AGENT][POSITIVE] OK, thanks for contacting AT have a good.