AccountId: 011433970860
ContactId: fcd1fcbd-e001-49b6-acd1-e0c9de090d7b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 277880 ms
Total Talk Time (AGENT): 138830 ms
Total Talk Time (CUSTOMER): 135668 ms
Interruptions: 4
Overall Sentiment: AGENT=1.1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/fcd1fcbd-e001-49b6-acd1-e0c9de090d7b_20250214T18:01_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, yes, I'm looking for a specific eligibility for a patient.
[AGENT][NEUTRAL] Yeah, I can check eligibility for you uh what was your name?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] [PII]?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yes, callback number [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And then if you have the policy number?
[CUSTOMER][NEUTRAL] doesn't.
[CUSTOMER][NEUTRAL] 02576313.
[AGENT][NEUTRAL] OK, thank you and what was the name and date of birth for the patient?
[CUSTOMER][NEGATIVE] Unfortunately we won't be here so the direct.
[CUSTOMER][NEUTRAL] The name and date of birth is [PII] [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that [PII]. So the policy is active. Effective date was [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] See you thank you bye bye.
[CUSTOMER][NEUTRAL] Now, specifically um for specialty consultations, uh, gastroenterology, do they need a referral?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No referrals are not required.
[CUSTOMER][NEUTRAL] Referrals are not required? Oh.
[AGENT][NEUTRAL] Right, this is, yeah, this is a limited indemnity medical plan, um, so it is there's no deductibles, copay, authorization, anything like that required it just pays a set dollar amount per covered procedure and office visit.
[CUSTOMER][NEUTRAL] Is it?
[CUSTOMER][NEUTRAL] Uh, so there's no, so it's like a PPO?
[AGENT][NEUTRAL] It's a bit different again it's uh just take that set dollar amount. It is a limited indemnity plan.
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][NEUTRAL] So that's the plan, unlimited you said?
[AGENT][NEUTRAL] Limited, limited indemnity medical plan. Yes.
[CUSTOMER][NEUTRAL] Or limited
[CUSTOMER][NEUTRAL] Limited
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] Plan. OK, so no.
[CUSTOMER][NEUTRAL] Co-pay, no authorization, no referral required.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] For anything?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] 00, that's OK, I like this then. OK, um, oh, sorry, what was your name?
[AGENT][NEUTRAL] It's uh [PII] and before you like it too much, um, I'm going to make sure because as this is a limited plan, um, I'm going to first make sure that office visits are in fact covered. You did say this was for a consultation was this um.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Please.
[AGENT][NEUTRAL] Like a wellness exam or a diagnostic?
[CUSTOMER][NEUTRAL] It says um
[CUSTOMER][NEUTRAL] It's, it's a routine.
[AGENT][NEUTRAL] It is routine, OK, so then.
[CUSTOMER][NEUTRAL] A routine for gastro, right?
[AGENT][NEUTRAL] OK, I believe that would fall under the wellness benefit then of course I will let you know that uh verification of coverage is not a guarantee of payment for claims, so they do have a wellness benefit on this policy. It pays up to $75 per visit.
[CUSTOMER][NEUTRAL] So there's a co-pay 75, is that what you're saying?
[AGENT][NEUTRAL] No, no, that's how much this plan this how that's how much the benefit amount is, yes.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][POSITIVE] Oh OK, OK, the benefits, so no copay, OK, good.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And who's the primary doctor, lets you say?
[AGENT][NEUTRAL] No, we don't have that kind of information.
[CUSTOMER][NEGATIVE] There's no OK.
[CUSTOMER][NEUTRAL] OK, um, so you.
[CUSTOMER][POSITIVE] So we are good, like it is covered, right?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] A wellness exam, yes, would pay $75.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Now what about the procedures?
[CUSTOMER][NEUTRAL] Like colonoscopy, endoscopy, do they need any referral? Colonoscopy?
[AGENT][NEUTRAL] Um, what kind of procedures?
[AGENT][NEUTRAL] Oh no, no, um, again, no, no referrals, anything like that is required. I believe a colonoscopy would fall under their diagnostic test benefit, but let me make sure, um, these are extremely specific as to what they do and don't cover. Um, let's see, yes, colonoscopy is covered under the diagnostic testing benefit, and that is $250 per test is the benefit amount.
[CUSTOMER][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] They're that. What are you?
[CUSTOMER][POSITIVE] Mm, OK, that's pretty good. OK then. OK, thank you very much and that's it.
[AGENT][NEUTRAL] Of course I know this is a bit of a different kind of plan. Um, did you have any other questions for me, [PII]?
[CUSTOMER][POSITIVE] No, I think that's good enough. I appreciate it.
[AGENT][POSITIVE] Alright, sounds good. You too, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][POSITIVE] Thank you, bye bye.
[CUSTOMER][NEUTRAL] OK.