AccountId: 011433970860
ContactId: e884a712-6553-486b-93e4-48121e986c57
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 516039 ms
Total Talk Time (AGENT): 126524 ms
Total Talk Time (CUSTOMER): 142243 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/e884a712-6553-486b-93e4-48121e986c57_20250610T18:12_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes ma'am, this is [PII]. I'm calling from Archro Primary Care and uh I just spoke with someone about eligibility for a patient, but I didn't know how many more visits they had this year, and she gave me your number.
[AGENT][NEUTRAL] Um, yes, ma'am. I can assist you with benefits. Um, first, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure it's [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII]. Now, could I get the policy number, please?
[CUSTOMER][NEUTRAL] Yes ma'am, it's D as in dog, 454-01495.
[AGENT][NEUTRAL] OK, that's not one of our policy numbers. Um, I can look her up by her social, the social or name and date of birth.
[CUSTOMER][NEUTRAL] OK, her social is [PII], and her date of birth is [PII].
[AGENT][NEUTRAL] OK, one moment, please.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, and please verify her name.
[CUSTOMER][NEUTRAL] Her name is uh [PII].
[AGENT][NEUTRAL] OK. And just let me advise you that verification of coverage does not guarantee payment of claims, and I have a policy number here if you need that.
[CUSTOMER][NEUTRAL] OK, yes, you can give that to me.
[AGENT][NEUTRAL] OK. Her policy number is 02518019.
[CUSTOMER][NEUTRAL] OK, so now let me ask you because this is what we're uh the card she gave us has that D.
[CUSTOMER][NEUTRAL] And the card has uh benefits in a card [PII]. Is this the correct um claims address?
[AGENT][NEUTRAL] Yes, ma'am, it is.
[CUSTOMER][NEUTRAL] OK, it's just that OK, so I'll just update the member ID number, OK.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Yes, ma'am. And is this for office visits?
[CUSTOMER][NEUTRAL] It is, it's for a 3 month follow up visit.
[AGENT][NEUTRAL] OK, one moment. Her benefits are coming up. One moment. Mhm.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, I'm not showing that office visits are covered under our policy. I am showing um
[AGENT][NEUTRAL] Like for diagnostic testing, she does have one visit per calendar year for a follow-up.
[AGENT][NEUTRAL] To test and that that we cover up to $25 for that.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, cause I mean the young lady I spoke with previous previously she said she has an active Max enhanced plan and it limited to 4 visits per person per year. So I asked her how many visits she had left for a follow-up visit and she said she didn't have that information, so.
[CUSTOMER][NEUTRAL] She asked me, also asked me if wellness or preventive uh was the appointment a wellness visit or a preventive visit, and I told her it wasn't.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEGATIVE] So basically this insurance is not um.
[CUSTOMER][NEUTRAL] There's no coverage for just a regular follow up office visit.
[AGENT][NEUTRAL] Um, I'm not showing on her policy, but let me get you over to the department and let you speak with an actual claim adjuster. Um, they may have more um information, but from what I can see, I'm not showing any coverage, but I'll get you over to someone that can give you more help, assist you further.
[CUSTOMER][NEUTRAL] With
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, that's fine. OK, thank you.
[AGENT][NEUTRAL] OK. Mhm. Is there anything else I can assist you with?
[CUSTOMER][POSITIVE] No, no, no, you've you've helped me tremendously, thank you.
[AGENT][POSITIVE] OK, no problem, and I'll get you transferred. One moment.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[AGENT][NEUTRAL] Um, hostel. This is [PII] Claims. Um, I have a provider on the line. She's calling to verify benefits for, um, hospital indemnity policy, and she's looking for office visit coverage, but I'm not seeing any on the policy, but she said she spoke with someone earlier who told her that there were, so could you further assist her?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm. Sure, yes. And what's her name?
[AGENT][NEUTRAL] Um, her name is [PII].
[AGENT][NEUTRAL] And her callback number is [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] What's the policy number?
[AGENT][NEUTRAL] The policy number is 251-8019.
[CUSTOMER][NEUTRAL] Did you verify the information uh of the member?
[AGENT][NEUTRAL] Yes, I've verified all her information.
[CUSTOMER][NEUTRAL] That's for [PII].
[AGENT][NEUTRAL] Yeah, that's her.
[CUSTOMER][POSITIVE] OK, perfect. OK, thank you.
[AGENT][POSITIVE] OK, here she is. Thank you.
[CUSTOMER][POSITIVE] You're welcome.