AccountId: 011433970860
ContactId: d47aa52a-4aae-4313-8828-63a9f37c5214
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 139059 ms
Total Talk Time (AGENT): 89240 ms
Total Talk Time (CUSTOMER): 39880 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/d47aa52a-4aae-4313-8828-63a9f37c5214_20250108T16:35_UTC.wav
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[AGENT][NEUTRAL] Contacting APL, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. I'm calling to obtain benefits for a member.
[AGENT][NEUTRAL] I can help with benefits. With whom am I speaking, please?
[CUSTOMER][NEUTRAL] This is [PII].
[AGENT][NEUTRAL] [PII], thank you. What's that policy number we're looking at today?
[CUSTOMER][NEUTRAL] Yeah. Policy number is 01788460.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Uh, patient's name is [PII], [PII].
[AGENT][POSITIVE] I appreciate that. Is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's uh [PII].
[AGENT][NEUTRAL] Thank you. The policy went into effect on [PII]. It is active. Now, this is a secondary or gap insurance with both inpatient and outpatient hospital services. The outpatient services, uh, such as outpatient hospital, the ER, treatment within the physician's office, or cancer treatment, durable medical.
[AGENT][NEUTRAL] Um, we will pick up the deductible, co-payment or co-insurance up to $1500 for calendar year. That's just a verification of the benefits, not a guarantee of payment for inpatient hospital stays of 18 hours or more, we pick up the deductible, co-payment or co-insurance up to $2500. Now I don't show that any of that has been used for the current year [PII]. Is there anything else that I can tell you about the secondary or gap insurance?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm sorry, you said that um outpatient surgery falls into that?
[AGENT][NEUTRAL] Yes, the outpatient surgery centers or uh either in a surgery center or a hospital, we will pick up the deductible, co-payment or co-insurance up to $1500. Again, just a verification, not a guarantee of payment. You'll file through their major medical first and then through us.
[CUSTOMER][NEUTRAL] Hospital.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] OK, perfect. That's all I need. It's up to 1500 and the full amount is available. Um, can I just have your name again and a call reference number?
[AGENT][POSITIVE] Yes, my name is [PII]. The first letter of my last name is [PII]. We're gonna use that today's date as a reference, and definitely, there's nothing else I can help you with, and thank you for contacting ATL. Hope you have a very good morning. Thank you for calling us.
[CUSTOMER][POSITIVE] Thank you.