AccountId: 011433970860
ContactId: ceb57f31-9bd7-46c6-8f22-bc0a3c7772ad
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 620580 ms
Total Talk Time (AGENT): 349138 ms
Total Talk Time (CUSTOMER): 238512 ms
Interruptions: 4
Overall Sentiment: AGENT=1.1, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/ceb57f31-9bd7-46c6-8f22-bc0a3c7772ad_20250401T14:20_UTC.wav
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[AGENT][POSITIVE] Thank you for contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hi [PII], I'm sorry. I'm like all over your recording right now. My name is [PII]. I'm calling from Doctor [PII]'s office. I'm actually calling to get benefits for patients and also if they need an authorization for an outpatient surgery.
[AGENT][POSITIVE] Yes, I can certainly help with that, Miss. What's the policy number, please?
[CUSTOMER][POSITIVE] Oh, you can. Awesome thank you [PII].
[AGENT][POSITIVE] Sure, absolutely.
[AGENT][NEUTRAL] What, what's the, is the policy number should begin with like a 01 or 02.
[CUSTOMER][NEUTRAL] I know what I have right here is D as in David 46401221.
[AGENT][NEUTRAL] Hm, OK. Um, how do you spell the patient's last name?
[CUSTOMER][NEUTRAL] It's [PII] His first name is [PII].
[AGENT][NEUTRAL] And his date of birth?
[CUSTOMER][NEUTRAL] His date of birth is [PII].
[AGENT][POSITIVE] Great, I can look it up by his name. Now, um, while I'm doing that, if I could just have a callback number please, in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Of course it's [PII].
[AGENT][NEUTRAL] OK, thank you. I'm just looking for this now.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] What's [PII]'s uh address?
[CUSTOMER][NEUTRAL] Um, I have [PII] is what I have.
[AGENT][NEUTRAL] OK, let me just see if I can't find him that way.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Sometimes they, uh.
[AGENT][NEUTRAL] What they will have is that they get to see their employer and sometimes they will have um multiple policy numbers and so let's just see whether.
[CUSTOMER][NEGATIVE] Oh, I know. I yesterday I tried to call and I was on hold for almost 2 hours and then it says to leave a message with your information so I did that and then I never got a call back. So today I had to come in early, so like I was like I wanna call first thing in the morning and I called and the.
[AGENT][NEUTRAL] Uh
[AGENT][POSITIVE] Oh, I'm sorry.
[AGENT][POSITIVE] Oh, bless your heart. Yeah.
[CUSTOMER][POSITIVE] I called again and then the other one had me on hold for a while and I'm like I'm gonna call back and I dialed I pushed another number and thank you for answering. I appreciate you thank you.
[AGENT][NEUTRAL] Oh no, [PII], I'm sorry you had that kind of trouble. Um, now his policy number, uh, with us, and like I said, it's, what they do is it's called Benes in the card and they have many different policy numbers. The one beginning with a D, which is the overall benefit one, the one that he has with us is 02.
[AGENT][NEUTRAL] 47
[CUSTOMER][NEUTRAL] I'm looking OK, let me write it down 0247 uh huh.
[AGENT][NEUTRAL] Yeah, that 4779.
[AGENT][NEUTRAL] 07. Now that went into effect on [PII], excuse me, [PII]. It is active. This is a hospital indemnity policy, and that means that what it does is it pays a flat rate benefit for the services that are covered. So let's look at this policy here, see if I can pull up this policy. Um, now, first of all, there's no pre-authorization on any of these. These are a limited benefit policy. This is not major medical.
[AGENT][NEUTRAL] So, for example, like for an office visit, it'll it'll pay a flat rate benefit. It doesn't pay um.
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] You know, it doesn't, there's not anything like, uh, pre-authorization, anything like that, that's not what we have. It is just pay that, is this pay that flat rate benefits? Let me see if I can't find his.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] And if it's for outpatient surgery. Now, normally that is covered under um
[AGENT][NEUTRAL] Under his office visits, uh, let's see.
[AGENT][POSITIVE] So they'll pay a flat rate benefit for that.
[CUSTOMER][NEUTRAL] So it'll be
[CUSTOMER][NEUTRAL] OK, so this is like an outpatient hospital, so it'll be done in a hospital. He's gonna have a robotic bilateral ingo hernia repair.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see if we can get this again.
[CUSTOMER][NEUTRAL] So does he have a new card that he knows that this is his policy because the card I have is just the group number of [PII] and then the ID number that I gave you which is partner's personal.
[AGENT][NEUTRAL] Right, he probably doesn't. It is confusing, yeah, because um what they do is they have uh multiple policies, um, and, uh.
[CUSTOMER][NEGATIVE] So confusing.
[AGENT][NEUTRAL] Yeah, OK, so this is gonna, OK, so what the, what the policy will do for outpatient hospital, um,
[AGENT][NEUTRAL] And this hospital that's actually inside a hospital. Now for a facility, um, uh, this is like an outpatient facility, is that correct?
[CUSTOMER][NEUTRAL] It's an outpatient hospital, mhm, not an ambulatory at the hospital.
[AGENT][NEUTRAL] Yes, so what we
[AGENT][NEUTRAL] All right, so what it will do is it'll pay up to $500 per occasion. He has one of those throughout the year. That's just a verification of the benefits, not a guarantee of payment. And um, what you will do is you will send the claim to uh [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. That's EA oh, I'm sorry, [PII]. That's the [PII] address.
[CUSTOMER][NEUTRAL] 2
[AGENT][NEUTRAL] And then [PII] is [PII].
[AGENT][NEUTRAL] Which is MN, which I don't always remember. I, um, and then the zip code is [PII].
[AGENT][NEUTRAL] And that is where uh
[CUSTOMER][NEUTRAL] And then
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Is it benefits in a card? Is that what it's called? Because I'm looking right at it. It's benefits in a card PO box, OK.
[AGENT][NEUTRAL] That's exactly it.
[AGENT][POSITIVE] Yeah, that's exactly what it is, um.
[CUSTOMER][NEUTRAL] So he, OK, so he doesn't have to pay anything. So when the hospital calls.
[CUSTOMER][NEUTRAL] Um, he doesn't have any kind of copay or any kind of deductibles or anything like that, correct?
[AGENT][NEUTRAL] Right, there's no co-pay.
[CUSTOMER][NEUTRAL] Oh, he pays the 500. I don't know.
[AGENT][NEUTRAL] Well, no, the, the $500 is all that it will pay. So let's just say that his surgery is $1000. We'll pay, we'll pay up to $500 of it, um, again, just a verification, not a guarantee of payment, and he'll pay the remainder. So that's the way that these things work. It's just, it's, um, it's not like a percentage the way they do with major medical Blue Cross, Blue Shield, that kind of thing. It's just the payment, and that is it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I see. OK, so like if my.
[CUSTOMER][NEUTRAL] When, because the way banner works is the hospital charges their end and then professional does their end. So basically it's almost like a
[CUSTOMER][NEUTRAL] Self pay I'm thinking because really he'll be responsible for the rest, right?
[AGENT][NEUTRAL] Uh, well, I can't, I mean, uh, all I can tell you is that our contractual obligation is at $500. So, um, he can, right, and he can certainly turn in a claim, absolutely, you know, he can certainly turn in a claim himself. You'll need to provide him with uh an itemized bill and the diagnosis code, but he can turn in the claim himself and, and we can pay him.
[CUSTOMER][NEUTRAL] And that's it. OK. The rest is up to him.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Whichever, you know, whichever you guys want to do, but yes, it, it does sound like it might end up being a self-pay type of thing, you know, but, but I would still go ahead and send in your, your uh claim just the same. I mean, you know, it's um.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And so is Banner University, are you guys contracted with all the hospitals and providers? Do you need MPI taxes or nothing? It's nothing like that type of insurance.
[AGENT][NEUTRAL] No, it's nothing like that because it is a limited benefit um policy that he has and so that he can go any place. There's not, we don't have a network of, of doctors, um.
[AGENT][NEUTRAL] He can go any place that, that uh he wants to and it's just that no matter where he goes, I'll put it that way, no matter where he goes, it's gonna be that exact same thing. um, so it's not, there's no inpatient, I mean excuse me, I'm sorry, there's no out of out of network policy or out of network uh uh um benefits. It's just, you know, wherever you go, that's it. That's what you're getting. So it's a flat, it's and it's, yeah, a hospital indemnity is what it's called, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, got it.
[AGENT][NEUTRAL] Confusing, but I mean it is pretty simple. Yeah, it is simple when, yeah, cause you, but you're not thinking of that, you know, you're thinking it has to be more, it's really not.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect. Well, that's good, that's good to know.
[AGENT][NEUTRAL] But if you, if you do have any questions, yeah, please call us. Yeah, and I'm sorry you had the trouble before, but um, is there anything else at all I could do? Anything else?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do you do uh call reference numbers [PII]?
[AGENT][NEUTRAL] Uh, it's my name and uh today's date. The first letter of my last name is [PII], and we're gonna use my name and uh what is it? [PII] [PII]. Oh my goodness, right.
[CUSTOMER][NEGATIVE] It is [PII]. I don't like April foodjos.
[AGENT][POSITIVE] I know, wow, we.
[AGENT][NEUTRAL] It's a
[CUSTOMER][NEGATIVE] I've already told my coworkers I don't wanna hear any April food jokes when you guys walk in and they just started laughing. They're like, Oh mom, this you're no fun.
[AGENT][NEUTRAL] Oh, I know. Well, you know, one time they put tape across the door, yeah, across the cubicles, so people would walk into the tape, but yeah, yeah, I wish people wouldn't do that, you know, grow up.
[CUSTOMER][NEUTRAL] And, and what's
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][MIXED] Well, sometimes some of them get kind of mean, you know, and I'm like, I don't like that, you know, it's funny, but I'm really bad. But [PII], um, what time do you have where you're at?
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Uh, it's [PII].
[CUSTOMER][NEUTRAL] Eastern Standard Time?
[AGENT][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Is that what it is?
[AGENT][NEUTRAL] I think we're Central time. I'm in [PII], so, um, I think it's, you know, when I was in school, I should have learned that.
[CUSTOMER][NEUTRAL] Eastern Standard Time.
[CUSTOMER][POSITIVE] Me too. I, I, I know that I'm mountain standard time. I learned that, but I never know where anybody else. I really don't travel that much, but thank you, thank you so much, [PII], for taking the time. I really appreciate all your help. Thank you.
[AGENT][NEUTRAL] I'm
[AGENT][POSITIVE] Well, thank you very much for contacting API. You have a very