AccountId: 011433970860
ContactId: e475a6d8-a1fb-4323-b30e-60a096326817
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 331980 ms
Total Talk Time (AGENT): 106170 ms
Total Talk Time (CUSTOMER): 117209 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/e475a6d8-a1fb-4323-b30e-60a096326817_20250404T17:40_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII], and I'm calling from the provider's office to check on the member's eligibility and benefits.
[AGENT][POSITIVE] OK, I'm happy to check on eligibility and benefits today. What's the patient's policy number?
[CUSTOMER][NEUTRAL] Uh, I have the policy number and that is going to be.
[CUSTOMER][NEUTRAL] Yes, that is 01792125.
[AGENT][NEUTRAL] All right, thank you for that. And do you have a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And if I can get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] I have the patient's name as [PII] with the date of birth of [PII].
[AGENT][POSITIVE] Thank you for that. The patient is active. It looks like the effective date on the plan is [PII].
[CUSTOMER][NEUTRAL] [PII], OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And still active, right?
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] May I know the plan type? Is it like PPO or HMO?
[AGENT][NEUTRAL] We are the members secondary insurance. This is a Medlink plan.
[CUSTOMER][NEUTRAL] Uh, [PII], what does that mean? Is it a supplement plan?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, may I know the supplement type? Is it like plan G or F or N?
[AGENT][NEUTRAL] There is no plan type in that sense. The name of the plan is Medlink.
[CUSTOMER][NEUTRAL] Um, may I know the benefits for the member?
[AGENT][NEUTRAL] Are you looking for outpatient or inpatient?
[CUSTOMER][NEUTRAL] Outpatient
[AGENT][NEUTRAL] No, this is verification of benefits, not guarantee of payment. The outpatient benefit amount for the calendar year is $5000.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Patient has the full amount remaining, it looks like.
[CUSTOMER][NEUTRAL] Uh, you mean the deductible patient did not me anything?
[CUSTOMER][NEUTRAL] Uh, like I just need the deductible out of pocket and the coinsurance.
[AGENT][NEUTRAL] OK. Well, there is no out of pocket or co-insurance. We're the secondary insurance. So this picks up any deductible, co-pay or co-insurance from the primary.
[CUSTOMER][NEUTRAL] Oh, I'm sorry, it won't pick any deductible or out of pocket or coinsurance.
[AGENT][NEUTRAL] We're the members secondary insurance, so we cover the deductible, the co-pay, or the co-insurance from the primary.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Up to $5000.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm sorry, up to $5000.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK, the member has accumulated anything in that $5000?
[AGENT][NEGATIVE] Nothing has been used. Nothing has been used.
[CUSTOMER][NEUTRAL] Or no.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And may I know does this requires any authorization?
[AGENT][NEGATIVE] No, it does not.
[CUSTOMER][NEUTRAL] No authorization is required. OK, um, uh, does this numbers plan covers DME coverage that like the durable medical equipment?
[AGENT][NEUTRAL] Uh, let me check one moment. Yes, it does.
[CUSTOMER][POSITIVE] OK, thank you, and I'm really sorry. Could you please help me with your name?
[AGENT][NEUTRAL] My name is [PII], which is [PII]
[CUSTOMER][NEUTRAL] And your last name initial?
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] And the call reference number for our call?
[AGENT][NEUTRAL] It's going to be my name with my last initials in today's date.
[CUSTOMER][NEUTRAL] I'm sorry, I forgotten to ask you the claim's mailing address. Could you please help me with that?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's in [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much. Have a good day, [PII].
[AGENT][POSITIVE] You as well. Take care.
[CUSTOMER][POSITIVE] Bye, thank you.
[AGENT][NEUTRAL] Bye bye.