AccountId: 011433970860
ContactId: d86bc4a6-aa03-40de-adbc-b732bc3f64cc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 271260 ms
Total Talk Time (AGENT): 132122 ms
Total Talk Time (CUSTOMER): 87349 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/d86bc4a6-aa03-40de-adbc-b732bc3f64cc_20250522T17:21_UTC.wav
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[AGENT][POSITIVE] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, I'd like to check on the benefits for a patient.
[AGENT][NEUTRAL] Um, yes, sir. I can assist you with benefits. Um, first, could I get your name and a good callback number?
[CUSTOMER][NEUTRAL] Name is [PII]. The number is [PII].
[AGENT][NEUTRAL] OK, thank you, [PII]. Now I need the policy number.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Let me find that um is that on the card it says oh I see I'm sorry, 167,124,930.
[AGENT][NEUTRAL] OK, please repeat that number.
[CUSTOMER][NEUTRAL] 167,124,930
[CUSTOMER][NEUTRAL] Actually that may be a different card that's not a number for you, is it?
[AGENT][NEUTRAL] No, sir. No one's coming up.
[CUSTOMER][NEUTRAL] OK, how about this? I, is it the benefit certification number, is that what you want? Or the payer ID?
[AGENT][NEUTRAL] Yes sir, that's the policy number, the benefit certification number.
[CUSTOMER][NEUTRAL] 02473436 ML 8
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Name is [PII]. Date of birth is.
[CUSTOMER][NEUTRAL] Where is that? One moment, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said again that policy number was 01957221?
[CUSTOMER][NEUTRAL] No, I said it was 02473436L8.
[AGENT][NEUTRAL] Can just let me advise you that verification of coverage does not guarantee payment of claims. The effective date on this policy was [PII] and the policy is still active.
[AGENT][NEUTRAL] Um, is this for inpatient or outpatient benefits or an office visit?
[CUSTOMER][NEUTRAL] Office visit and outpatient benefits.
[AGENT][NEUTRAL] OK, for outpatient, we cover up to $300 per day and that's for the co-pay, the co-insurance, and the deductible after the primary insurance processes the claim for services that takes place in outpatient facilities, um, for services provided in office. I'm showing that there's no coverage unless um it's for cancer treatment.
[CUSTOMER][NEUTRAL] It is for cancer treatment.
[AGENT][NEUTRAL] OK. Well, then it's also covered um up to $300 per day for the copay, the co-insurance, and the deductible.
[CUSTOMER][NEUTRAL] OK, so for surgery, the maximum you pay for outpatient surgery is $300.
[AGENT][NEUTRAL] Yes, sir, per day.
[CUSTOMER][NEUTRAL] Well, the surgery is only one day.
[AGENT][NEUTRAL] Yeah, well, if the patient is admitted um for inpatient admissions, we'll cover up to $5000 per admission. But if it's just for outpatient surgery just for that day, then yes, sir, it's $300.
[CUSTOMER][NEUTRAL] So if it's done as an outpatient, you'll pay the surgeon a maximum of $300 is that correct?
[AGENT][NEUTRAL] Yes, sir. The charges that goes towards the copay, the co-insurance, and the deductible for the surgery, um, the provider fees, um, all for 3, we cover up to 300 per day.
[CUSTOMER][NEUTRAL] But if she's admitted that you cover up to 5000?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] So that's an incentive to admit a patient, don't you think?
[AGENT][NEUTRAL] I don't write the policy. Yeah.
[CUSTOMER][NEUTRAL] Not sure why
[CUSTOMER][NEUTRAL] Understand, OK, and I'm assuming nothing's been met on any of those, correct?
[AGENT][NEUTRAL] Um, for the outpatient service, no, because it's a daily benefit. Um, I can check and see for inpatient. Well, inpatient is per admission, so that's correct.
[AGENT][NEUTRAL] Nothing's been met so far.
[CUSTOMER][NEUTRAL] For admission.
[CUSTOMER][POSITIVE] Thank you very much. What was your name?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] It's [PII]. Um, it's spelled [PII] and my last initial is [PII] and your reference number will be my name and today's date. Um, is there anything else I can assist you with?
[CUSTOMER][POSITIVE] Oh thank you very much.
[AGENT][POSITIVE] Yeah, thank you, [PII], for calling ATL. You have a great day. Mm bye.