AccountId: 011433970860
ContactId: ff887e63-abcb-4a5d-a7f1-618ab642048b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 248740 ms
Total Talk Time (AGENT): 108937 ms
Total Talk Time (CUSTOMER): 101641 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/ff887e63-abcb-4a5d-a7f1-618ab642048b_20250527T17:13_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Thank you for calling
[CUSTOMER][NEUTRAL] Yes, hi, um.
[CUSTOMER][NEUTRAL] I'm calling from a provider's office, a specialist, and I wanted to check on the um benefits of this patient that has APL during [PII] apparently it did cover copays, but I don't know that now.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, what's your name and a good phone? Oh, what's your name and a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Can I get
[CUSTOMER][NEUTRAL] My name is [PII] and this is [PII].
[AGENT][NEUTRAL] And what's the policy number?
[CUSTOMER][NEUTRAL] 02465834.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] And what were you needing?
[CUSTOMER][NEUTRAL] So if this is for an outpatient, uh, visits, um, a specialist visits, uh, if there is any coverage for copays.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, first name is [PII], last name [PII], and it's [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you have the data service for this claim or are you?
[AGENT][NEUTRAL] Needing to file the claim.
[CUSTOMER][NEUTRAL] I'm not sure if.
[CUSTOMER][NEUTRAL] No, not to, not to file a claim, but, uh, not sure if it was sent, but in any case, the, uh, I, I wanna make sure if it is covered or not. The it was [PII] the the visit.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It was on [PII]. OK, um, the policy number you gave me has an effective date of [PII], and it lapsed on [PII]. Let me see if [PII] has any more.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, here we go.
[AGENT][NEUTRAL] Let me give you the new policy number.
[CUSTOMER][POSITIVE] OK, I'm ready.
[AGENT][NEUTRAL] It's 02.
[AGENT][NEUTRAL] 583-674
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that policy has an effective date of [PII] and it is active.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It is a medlink policy, so it's secondary gap insurance, meaning that the primary insurance carrier will need to pay first, and we will need their explanation of benefits or EOB with the claim that you submit and you are wanting to know about a specialist.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Well, it does it cover the policy co-pays for the visit?
[AGENT][NEUTRAL] Yes, this, this policy does co-pay, co-deductible and co-insurance.
[AGENT][NEUTRAL] So as long as the primary files and pays partial benefits, um, as long as it's a covered service, it should be covered under this policy as well.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, and have you received any claims for [PII]?
[AGENT][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] It's, it's too early, I would say.
[CUSTOMER][NEUTRAL] Yeah, because Aetna is the primary insurance and they just answer on the [PII], yeah.
[AGENT][NEUTRAL] Uh, for [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm not showing a claim for that date of service.
[CUSTOMER][POSITIVE] All right, very well.
[AGENT][NEUTRAL] Yeah. Do you need our fax number?
[CUSTOMER][POSITIVE] Well thank you so much.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, no, no, no, that's fine, thank you.
[AGENT][POSITIVE] OK. Thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye.