AccountId: 011433970860
ContactId: f3de384e-8f60-409f-9ad8-f0805ccd624d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 274079 ms
Total Talk Time (AGENT): 150988 ms
Total Talk Time (CUSTOMER): 98239 ms
Interruptions: 2
Overall Sentiment: AGENT=1.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/f3de384e-8f60-409f-9ad8-f0805ccd624d_20250318T14:07_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, yes, my name is [PII] and I work for Doctor [PII], and we have a patient with this insurance and we're not sure if it's something that we take or not. Is there a way you can check if we're in network or how that works?
[AGENT][POSITIVE] Yes ma'am, I can help you with the benefits um in that networking of patients. Ms. [PII], what is your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Sure it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And then can you give me the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Um, so do you want the subscriber or do you want this is a dependent it's a pediatrician so.
[AGENT][NEUTRAL] The, the patient, please.
[CUSTOMER][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK. And then, yes.
[CUSTOMER][NEUTRAL] And the policy is 02559169.
[AGENT][NEUTRAL] OK, let me look up that policy real quick.
[AGENT][NEUTRAL] OK, I am showing that [PII] does have an active policy. Uh, his effective date is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] This is a hospital indemnity plan. It's a limited hospital indemnity plan. So with this plan, they can see anybody they want to see. It's not uh in network. So what
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And this is just to verify the benefits. It's not a guarantee of payment. So if he goes into the hospital, he has um one day per calendar year that pays $2000.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, he also has, uh, outpatient for accident or sickness benefit for the ER urgent care center or physician's office. Um, the ER pays 300, the urgent care pays 100, and the physician's office also pays 100.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then so there's no preventative or anything like that.
[AGENT][NEUTRAL] And that's
[AGENT][NEUTRAL] Right, so it's um.
[CUSTOMER][NEUTRAL] Right, it doesn't cover any well checks or anything.
[AGENT][NEUTRAL] Uh, let me pull up their policy and read it to see if well checks are on their policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's gonna be just a second while the computer pulls it in and I'll have to read it um for wellness.
[CUSTOMER][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] Is there a way can you fax it to me?
[AGENT][NEUTRAL] A whole complete policy?
[CUSTOMER][NEUTRAL] Yeah, like, or just like if you have like a benefits thing or.
[AGENT][NEUTRAL] We don't have that.
[CUSTOMER][NEUTRAL] Anything like that? I don't know if you got that. OK, OK.
[AGENT][NEUTRAL] No, ma'am, we don't have that.
[CUSTOMER][NEUTRAL] OK, and then is there an electronic payer ID or no?
[AGENT][NEUTRAL] Yes, ma'am. Let me give that to you.
[AGENT][NEUTRAL] Uh, it is 60801.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And um we also have a fax number that you can send claims to and a mailing address. Would you like both of those?
[CUSTOMER][NEUTRAL] OK, is that the [PII]?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] And then the [PII].
[AGENT][POSITIVE] Yes, ma'am. That's right. That's right.
[CUSTOMER][POSITIVE] Perfect. OK.
[AGENT][NEUTRAL] OK, so looking at the policy, it looks like he just has it for um it's an accident or sickness benefit.
[CUSTOMER][NEUTRAL] OK, alright, so no wellness.
[CUSTOMER][POSITIVE] OK awesome thank you so much.
[AGENT][POSITIVE] Well, you're very welcome, Ms. [PII].
[CUSTOMER][NEUTRAL] And then is there, is there a number um sick visits?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] No, unlimited sick visits just it pays up to $100.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So it's something that we file first.
[AGENT][NEUTRAL] Yes, ma'am. You would file with, with our, with um the claim with us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Perfect thank you so much all right have a good day.
[AGENT][POSITIVE] OK. You're welcome, Ms. [PII]. You're welcome. You too. Thank you and thanks for calling APL. Bye bye.
[CUSTOMER][NEUTRAL] OK bye bye.