AccountId: 011433970860
ContactId: e8097a8c-8ace-494f-9300-1aa8d5f8bc94
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 152860 ms
Total Talk Time (AGENT): 85300 ms
Total Talk Time (CUSTOMER): 50077 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/e8097a8c-8ace-494f-9300-1aa8d5f8bc94_20250116T14:24_UTC.wav
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[AGENT][NEUTRAL] APL, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. This is uh [PII].
[AGENT][POSITIVE] Good morning.
[CUSTOMER][POSITIVE] I'm calling from Cleveland Clinic, Florida and it's still very eligibility and benefits for a patient.
[AGENT][NEUTRAL] I can help with eligibility and benefits. [PII], what's that policy number, please?
[CUSTOMER][NEUTRAL] 0228066 M as in Mike L as in Lima and the number 8.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you, is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the extension is [PII].
[AGENT][NEUTRAL] Thank you. The policy went into effect on [PII]. It is active. This is the secondary or gap insurance. It's meant to pick up the deductible, co-payment or co-insurance from their major medical.
[AGENT][NEUTRAL] So for outpatient services, they will pick up the deductible, co-payment or co-insurance up to $2000.
[AGENT][NEUTRAL] For inpatient, they will pick up the deductible, co-payment or co-insurance up to $4000 and that's just a verification of the benefits, not a guarantee of payment. Is there anything else that I may help with?
[CUSTOMER][NEUTRAL] With
[CUSTOMER][NEUTRAL] Of the deductible copayment.
[CUSTOMER][NEUTRAL] OK, so being a secondary policy does not have a network, I believe.
[CUSTOMER][NEUTRAL] It's like an open axis.
[AGENT][NEUTRAL] This is, this is a secondary policy, yes.
[CUSTOMER][NEUTRAL] This is, this is a secondary policy.
[CUSTOMER][NEUTRAL] OK, and so there are no requirements like uh PCP referral or an authorization for an office visit.
[AGENT][NEUTRAL] No, no, it's, it, it, it just covers inpatient and outpatient hospital as long as there is a deductible, co-payment or co-insurance from the major medical, then we're fine. Um, you know, that's, they have to have available benefits, but, uh, otherwise, that's all that we're looking for is that you have an explanation of benefits from their primary insurance, showing a deductible, co-payment or co-insurance. So any sort of pre-off, any, any sort of um verification, uh, you would do that with their primary insurance but not with us.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] OK, got it. Well, perfect, thank you so much. That will be all. I just need the the reference number please.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Uh yes, my name is [PII]. The first letter of my last name is [PII], and we'll use that today's date as a reference. There's nothing else I can help with, and thanks for contacting ATL. Have a good day.