AccountId: 011433970860
ContactId: cfb337ca-4e72-4704-8869-993adddd788e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 514080 ms
Total Talk Time (AGENT): 242634 ms
Total Talk Time (CUSTOMER): 215789 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/cfb337ca-4e72-4704-8869-993adddd788e_20250507T16:47_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, um, good afternoon, [PII]. I just needed some benefits information for a patient, um, just let me know what you need to get her pulled up.
[AGENT][NEUTRAL] OK, I can help you with benefits. Um, may I please get your name and your callback number and the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] Of course, my name is [PII]. A callback number is [PII], and the facility is actually the name of the physician [PII].
[AGENT][POSITIVE] Thank you very much for giving me that information. And what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] OK, the name is [PII]. Last name is [PII]. Date of birth is [PII], and the policy number is 01262475.
[AGENT][NEUTRAL] OK, let me look up the policy real quick.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, I do show that this policy for Ms. [PII] is no longer active. The policy terminated on [PII].
[AGENT][NEUTRAL] But I'm checking to see if she has an active policy. She does, let me give you the good policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, go ahead.
[AGENT][NEUTRAL] That policy number is 259-6839.
[CUSTOMER][NEUTRAL] OK, hold on one second.
[AGENT][NEUTRAL] And her effective date for this policy is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 1st of [PII], do you have the group number for the policy?
[AGENT][NEUTRAL] Yes, ma'am. It's 16,690.
[CUSTOMER][NEUTRAL] OK, and let me just repeat back that policy number because I wasn't completely ready. sorry, 259-683-9, right?
[AGENT][NEUTRAL] That
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] And let me see now I just wanted to know um hold on.
[CUSTOMER][NEUTRAL] Um, OK, so now does she have, uh.
[CUSTOMER][NEUTRAL] Sorry, since it's a secondary, this is supplemental, um, does she have any co-pay, co-insurance, deductible? Can you give me that information?
[AGENT][NEUTRAL] It's OK.
[AGENT][NEUTRAL] Yes ma'am, I can, and this is just to verify her benefits. It's not a guarantee of payment. Uh, she does have a supplemental insurance policy that does help with deductible, co-pay and co-insurance. She has an inpatient per calendar year benefit amount of $3000 and then she also has an outpatient per calendar day benefit of $500.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] What uh.
[CUSTOMER][NEUTRAL] OK, so does she, when, sorry, when she comes in for an office visit in a specialist office, does there, sorry, I'm new to verifying and I'm really unsure in regards to the supplemental. I just need to know if she needs to pay.
[AGENT][NEUTRAL] That's OK.
[AGENT][POSITIVE] We've, we've all been new and I will help you all that I can, OK? I'm gonna look on her, um, policy cert you're very welcome. I'm very understanding, um.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm gonna look on her policy certificate and see if she has office visits on her policy or if it's just for treatment. So let me check real quick.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're very welcome. OK, so this policy does not cover the office visit uh for the physician's fee.
[AGENT][NEUTRAL] It just covers for treatment in the office.
[CUSTOMER][NEUTRAL] So would that be considered like testing?
[AGENT][NEUTRAL] And it does.
[AGENT][NEUTRAL] Right, and it does go towards the deductible, co-pay or co-insurance only.
[AGENT][NEUTRAL] But the physician's office visit fee will not be covered, so she doesn't have office visits on her policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, but it does cover.
[CUSTOMER][NEUTRAL] The, the testing, so if she.
[CUSTOMER][NEUTRAL] So it's just the can I give you the CPT codes or I don't, I'm not sure. I just wanna know um if the testing's covered 100% or or subject.
[AGENT][NEUTRAL] No, it goes by.
[AGENT][NEUTRAL] Right, it, it goes by um based on what the primary pays and if the primary um shows the deductible co-pay or co-insurance on their EOB that's sent in with the claim.
[CUSTOMER][NEUTRAL] OK, so it kind of follows whatever the testing, whatever the primary covers, it kind of follows the same guideline. So if it's subject to the the uh.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] So we really won't know until the EOB is sent in from the primary, so you send in the EOB.
[CUSTOMER][NEUTRAL] Is there any like.
[AGENT][NEUTRAL] To us and file the claim but on this policy office visits are not covered and let me see about lab.
[CUSTOMER][NEUTRAL] No, no, don't worry about lab it so all we do in the office is diagnostic testing. So if it covers the testing, I just don't know how to know. Does it cover it up to a certain amount?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK, let me see. That is um for the calendar year benefit. The 5 or I'm sorry, the per calendar day benefit of $500. Once that $500 is exhausted for that day, it will stop paying because it'll max out the benefit for the calendar day.
[CUSTOMER][NEUTRAL] Or that's all kind of uh.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] But it'll pay up to 500 per day.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, OK, now this question, I don't know if it's gonna make any sense, but, um, it's making me think like, so if she has like a 10%.
[CUSTOMER][NEUTRAL] No, what am I trying to say? um.
[CUSTOMER][NEUTRAL] It, I mean, it seems to cover the testing no matter what. I, I would assume because the mm mm, I'm trying to read based off her plan last year subject to deductible covered 100% after deductible hm.
[AGENT][NEUTRAL] It's OK.
[AGENT][NEUTRAL] So her, her, um, her benefits are good and uh um
[AGENT][NEUTRAL] Covered outpatient facility.
[AGENT][NEUTRAL] Not an office visit.
[CUSTOMER][NEUTRAL] OK, yes, we're now we're out. OK, so it doesn't do anything in regards to copay, just testing, but it'll cover the testing 100% as long as it's done in a in network outpatient like doctor's office, basically, right?
[AGENT][NEUTRAL] Not enough. OK, good.
[AGENT][NEUTRAL] Right, in an ER urgent care center, MRI imaging center or an outpatient facility that's associated with the hospital, um, it ambulatory center.
[AGENT][NEUTRAL] But not
[CUSTOMER][MIXED] OK, but outpatient like a specialist office it covers.
[AGENT][NEUTRAL] No, it does not cover office visits.
[CUSTOMER][NEUTRAL] No, but it covers the testing like any diagnostic testing.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Like ultrasound, OK, OK, oh thank you. What, what is, um, can you just give me your first name again and your last initial?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Yes, my first name is [PII]
[AGENT][NEUTRAL] And my last initial is [PII]
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And a reference number for the call please.
[AGENT][NEUTRAL] Yes, ma'am. You can use my name and today's date.
[CUSTOMER][POSITIVE] Oh perfect thank you so much [PII] I appreciate your patience with me.
[AGENT][POSITIVE] Oh, it's no problem at all. Like I said, we've all been new and you just, you'll, you'll get good at it. You'll do it so much it'll be like the back of your hand.
[CUSTOMER][NEUTRAL] It just takes time, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Uh thank you so much have a great day.
[AGENT][POSITIVE] You have a wonderful day too, and thank you for calling ATL Ms. [PII].
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Bye bye.