AccountId: 011433970860
ContactId: e6e60920-f12f-40db-962f-6d12960dfe2a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 291529 ms
Total Talk Time (AGENT): 146525 ms
Total Talk Time (CUSTOMER): 119823 ms
Interruptions: 2
Overall Sentiment: AGENT=1.3, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/e6e60920-f12f-40db-962f-6d12960dfe2a_20250318T13:16_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh yes, I am trying to see if I can get eligibility and benefits on a patient please.
[AGENT][NEUTRAL] Sure, I can assist you with the eligibility and benefits. And may I have your name?
[CUSTOMER][NEUTRAL] My name is [PII] just like the month and I'm sorry and yours is?
[AGENT][NEUTRAL] So, [PII] last initial [PII]
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome, Miss. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And may I have the name of the facility you're calling from, Ms. [PII]?
[CUSTOMER][NEUTRAL] The laser and surgery center of the Palm Beaches.
[AGENT][NEUTRAL] OK, and may I have the patient's policy number?
[CUSTOMER][NEUTRAL] It is 02107014 ML8.
[AGENT][NEUTRAL] Mm. All right. And may I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Uh, that is [PII], [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Let me check and see if I have a new policy. This one is terminated, bear with me.
[AGENT][NEUTRAL] OK, I did find a new policy.
[AGENT][NEUTRAL] And let's see. I, I did, I did find a new policy. Let me know when you're ready for that new number.
[CUSTOMER][NEUTRAL] You did? I'm sorry, or you didn't.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Um, I'm ready, please.
[AGENT][NEUTRAL] OK, the new number is 02.
[AGENT][NEUTRAL] 545776.
[AGENT][NEUTRAL] The effective date. Mhm. Go ahead.
[CUSTOMER][NEUTRAL] OK, so you said
[CUSTOMER][NEUTRAL] OK, I just wanted to repeat it back to you said 02545776.
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, the effective date on this one is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It is active at the moment and this is one of our secondary supplemental plan to the major medical.
[AGENT][NEUTRAL] And let me give you benefits and you need outpatient benefits?
[CUSTOMER][NEUTRAL] Yeah, the patient's coming in, she's actually coming in for a cataract surgery, um, so with Aetna she does have a large deductible, so I just need to know how you guys are gonna pay. Are you gonna pay that deductible or does she have to meet her deductible before secondary picks up anything?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We cannot guarantee any payment over the phone, but yes, this policy is set up to help with the deductibles, co-payment, and coinsurance. So basically we picked up.
[CUSTOMER][NEUTRAL] So it's like a plan F?
[CUSTOMER][NEUTRAL] So, so you do pick up the deductible co-insurance co-pay.
[AGENT][NEUTRAL] Um, I'm sorry.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, is there a group number?
[AGENT][NEUTRAL] Let me give you the benefits because it's not the whole thing so let me give you the benefits and this is not a guarantee of payment just a verification of coverage. Outpatient maximum is 1500 per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK, so she has a deductible with you as well.
[AGENT][NEUTRAL] No, Maximum benefit that we pay to help with that deductible is 1500. Mhm. Yeah.
[CUSTOMER][NEGATIVE] Oh, OK, you, you're, you're echoing, so I'm not getting it all, so you're gonna pay up to $1500.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Correct, yes. Mhm.
[CUSTOMER][NEUTRAL] OK, let me just OK.
[CUSTOMER][NEUTRAL] So you're going to pay up to $15.
[AGENT][NEUTRAL] 1500, mhm, yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And that's for the calendar year, correct?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] OK, and then, um, after you pay that $1500 do you pay anything else? Or no, that's it?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] That's it for the outpatient. She does have inpatient benefits, but that's like if she's hospitalized or an observation. Mhm, yeah.
[CUSTOMER][NEUTRAL] Yeah, well, no, yeah, we're, we're definitely outpatient. OK, uh, so can I just get a reference number for the call please?
[AGENT][NEUTRAL] Outpatient, yeah. Mhm.
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will, Miss [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] Today's date excellent all right thank you so much for your help you have a great rest of your day.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] You're welcome. You as well, and thank you for calling ATL. Bye-bye, Ms. [PII].
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Alright, oh, you know, I'm sorry, I do have one more question. Does she use any of that $1500 as of yet?
[AGENT][NEUTRAL] Yeah, uh, go ahead. Yeah, oh, sure.
[AGENT][NEUTRAL] OK, let me check on that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I'm sorry about that. It just dawned on me.
[AGENT][POSITIVE] It's OK, no problem. I understand.
[AGENT][NEUTRAL] Let's see. Oh, she has not used her benefits for [PII] as of today, so she still have the full amount available.
[CUSTOMER][POSITIVE] OK all right thank you so much for your help have a great day.
[AGENT][POSITIVE] Mhm. You're welcome. You as well, Miss [PII]. Bye-bye.
[CUSTOMER][NEUTRAL] Mm bye-bye.