AccountId: 011433970860
ContactId: d7ed0466-c7c1-4a7b-94b2-2e1215202351
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 364320 ms
Total Talk Time (AGENT): 174222 ms
Total Talk Time (CUSTOMER): 110428 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/d7ed0466-c7c1-4a7b-94b2-2e1215202351_20250108T21:26_UTC.wav
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[AGENT][NEUTRAL] For contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. My name is [PII] calling from Genoch Access Solutions. At the request of the provider on behalf of the patient, this call may be monitored and recorded for training purposes, checking eligibility and benefits.
[AGENT][NEUTRAL] I can help with the eligibility and benefits. [PII], what's that policy number we're looking at today?
[CUSTOMER][NEUTRAL] [PII] direct line.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, how do you spell the patient's last name?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] I mean [PII]
[AGENT][POSITIVE] Thank you, and their, their first name?
[CUSTOMER][NEUTRAL] [PII], and [PII], date of birth.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So it's [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] [PII] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there a callback number can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. Um, [PII]'s policy number is 02.
[AGENT][NEUTRAL] 57
[AGENT][NEUTRAL] 8793.
[CUSTOMER][NEUTRAL] 0
[AGENT][NEUTRAL] That went into effect on [PII]. It is active. Now, this is a secondary or gap insurance. It's meant to pick up the deductible, co-payment or co-insurance from his major medical for inpatient and outpatient services as well as treatment within a physician's office. Is there any particular benefit that I can help with?
[CUSTOMER][NEUTRAL] Uh, yes, I have, do you take CBD calls or description?
[AGENT][NEUTRAL] Well, it doesn't, um, I'm sorry, what, what this does is it does inpatient and outpatient hospital. It that's what it covers.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK, so only, OK, so it's done in a specialist office visit.
[AGENT][NEUTRAL] Now, the treatment within the
[CUSTOMER][NEUTRAL] Um, so it wouldn't
[AGENT][NEUTRAL] Well, the treatment within the specialist office is covered. Now, that is covered up to $4000 per calendar year, and that's just a verification of the benefits, not a guarantee of payment. There is a $100 deductible.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] For this. But treatment within the physician's office um is covered. Now, that has not been met this uh calendar year, um, cause he, of course, he just got it, um, but, um,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, yes, that's, uh, that's what the policy does.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] OK, I'm trying to figure because the previous had no injection benefits or something.
[CUSTOMER][NEUTRAL] And I wasn't sure why.
[AGENT][NEUTRAL] Uh, so you mean you turned something into us before, um,
[CUSTOMER][NEUTRAL] Yeah, I'm looking at the previous um um it was done in back in March, I mean February of last year.
[AGENT][NEUTRAL] Let's check.
[CUSTOMER][NEUTRAL] It has
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] No benefit for injection?
[CUSTOMER][NEUTRAL] Or infusion.
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] Now that might let me just check. Sorry, just a second here.
[AGENT][NEUTRAL] Checking.
[AGENT][NEUTRAL] So this, uh, the policy that he had before.
[AGENT][NEUTRAL] Um, had an office visit, uh, coverage, um, but it's, it just pays the flat rate benefit of $25 and I don't have anything from March of last year, um, but, um, if it's something had been done within the physician's office, it would just pay that flat rate benefit of $25. Um, so that was the policy that he had, uh, at that time. Now that, of course, they renewed the group, um,
[AGENT][NEGATIVE] This is group uh gap insurance. And so, uh, what the group did was they updated their insurance and uh what's, um, what is covered now is treatment within the physician's office. Now, um, infusion therapy is not covered. It it's, it's still not gonna be covered under this policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But treatment within the physician's office would be.
[CUSTOMER][NEUTRAL] Mm, OK, so treatment in uh OK.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Um, and so it's technically a 100% co-insurance and then they got the $100 deductible.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, and then no out of pocket or?
[CUSTOMER][NEUTRAL] Hm
[AGENT][NEUTRAL] Well, just that, there, there's a $100 deductible. So that, that would be a.
[CUSTOMER][NEUTRAL] OK, that's it. OK.
[CUSTOMER][NEUTRAL] OK, OK, I got it.
[CUSTOMER][NEUTRAL] Alright, um, and then for the ID number you said 025787? I feel like I'm missing two numbers.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Sure, it's 0257.
[AGENT][NEUTRAL] 879 3.
[CUSTOMER][NEUTRAL] 93 OK got it alright uh if I could just have first initial to your last name and a call reference.
[AGENT][NEUTRAL] Yes, it's [PII], and we're gonna use that today's date as a reference.
[CUSTOMER][POSITIVE] All right, thank you so much for your help. Enjoy the rest of your day.
[AGENT][POSITIVE] Thanks for contacting AP have a good day.