AccountId: 011433970860
ContactId: dceae7d4-8ee3-48d9-9604-d1380ef0e75b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 296809 ms
Total Talk Time (AGENT): 119685 ms
Total Talk Time (CUSTOMER): 129630 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/07/dceae7d4-8ee3-48d9-9604-d1380ef0e75b_20250207T19:59_UTC.wav
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[AGENT][NEUTRAL] Calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][POSITIVE] Thank you for calling ATL. This is thank you for calling.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][POSITIVE] Yeah thank you this.
[AGENT][POSITIVE] Thank you for
[AGENT][NEUTRAL] I'm trying to announce my name. This is [PII] with American Public Life. This is how may I help you?
[CUSTOMER][NEUTRAL] Thank you. This is, I'm calling you for send over the agnostic image. I have a multi patient by the name [PII]. It's just to see if you.
[AGENT][NEUTRAL] OK, let me first get your name, ma'am. Can you spell your name for me?
[CUSTOMER][NEUTRAL] Yes, [PII]
[AGENT][NEUTRAL] And you said that you're calling for what reason?
[CUSTOMER][NEUTRAL] Center for diagnostic imaging it's just to verify for the patients need um.
[CUSTOMER][NEUTRAL] If you guys are gonna cover?
[AGENT][NEUTRAL] Are you needing
[CUSTOMER][NEUTRAL] Her deductible, mhm.
[AGENT][NEUTRAL] So are you needing benefits?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, where is the service in an office or outpatient facility?
[CUSTOMER][NEUTRAL] Office.
[AGENT][NEUTRAL] OK, and what is the policy number?
[CUSTOMER][NEUTRAL] Yeah, I have here.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Wait, I have the group and then they have the in hospital outpatient, it will be numbers are 02111152 M like Mary, L like Larry, number 8.
[AGENT][NEUTRAL] OK, what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] I think it's [PII].
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Insurance is
[AGENT][NEUTRAL] And what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] The date of birth is?
[CUSTOMER][NEUTRAL] [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK, the policy effective date is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The policy is active at this time.
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] And under this policy, the physician's fee is not covered.
[CUSTOMER][NEUTRAL] Uh, OK, so.
[CUSTOMER][NEUTRAL] She's still active?
[CUSTOMER][NEUTRAL] OK, but you guys don't gonna cover the deductible amount, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The physician's fee is not covered.
[CUSTOMER][NEUTRAL] OK, the physician.
[AGENT][NEUTRAL] If there's treatment in the office, this policy has a treatment writer, so covered treatment in the office can be considered, but the copay for the physician's fee is not covered.
[CUSTOMER][NEUTRAL] OK, OK, so she have United Healthcare.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And she has a high deductible.
[CUSTOMER][NEUTRAL] She's here doing a CT scan, so meaning that, so you meaning that is a radiology you guys don't cover radiology.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, that's treatment. An MRI is a form of treatment. Is it being done in a diagnostic facility or a specialist office?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Specialist diagnostic facility.
[AGENT][NEUTRAL] OK, so in that case, the maximum outpatient benefit is up to $500.
[AGENT][NEUTRAL] Her calendar day.
[CUSTOMER][NEUTRAL] OK, so you guys will not cover.
[AGENT][NEUTRAL] OK, if it's a, if it's a diagnostic test in an MRI facility, so it's, it's not.
[CUSTOMER][NEUTRAL] It's a CT scan.
[AGENT][POSITIVE] Yes, which is treatment. They do have a treatment writer, so now I'm giving you the benefit for the.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Diagnostic test.
[AGENT][NEUTRAL] Which is up to $500 per calendar day.
[CUSTOMER][NEUTRAL] OK, so just trying to understand you guys are gonna cover only $500.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Correct. The maximum outpatient benefit is up to $500 per calendar day.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So you guys have a secondary gap, you guys gonna be only covered $500.
[AGENT][POSITIVE] Up to 500. That, that is correct.
[CUSTOMER][NEUTRAL] If it's more
[CUSTOMER][NEUTRAL] If it's more than if it's more than $500 the patient will be responsible.
[AGENT][NEUTRAL] We do not determine patients responsibility.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, can I get a reference number?
[AGENT][NEUTRAL] My name and today's date [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] First initial of my last name is [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And did you have any other questions?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome thank you for calling ATL. Have a good day.
[CUSTOMER][NEUTRAL] Bye bye.