AccountId: 011433970860
ContactId: 02c99472-6664-4e41-b97a-e01468fe6e44
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 153619 ms
Total Talk Time (AGENT): 62440 ms
Total Talk Time (CUSTOMER): 66060 ms
Interruptions: 0
Overall Sentiment: AGENT=1.9, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/02c99472-6664-4e41-b97a-e01468fe6e44_20250225T18:04_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling to check if a member is eligible with the plan.
[AGENT][POSITIVE] Alright, I'm happy to check eligibility today. What is the policy number?
[CUSTOMER][NEUTRAL] It is 1, 02455025, M as in Mary, L as in Lima, 7.
[AGENT][POSITIVE] All right, thank you so much. And then patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] Thank you so much. So the patient plan is active. The effective date is [PII]. This is a secondary insurance, so it will cover deductible, co-pay, and co-insurance. The primary does not.
[CUSTOMER][NEUTRAL] OK, thank you. And can you provide me the deductible and deductible amount that this uh patient has?
[AGENT][NEUTRAL] Um, let me take a look one moment.
[AGENT][NEUTRAL] Uh, there's no deductible on the member's plan. The outpatient benefit max for a calendar day would be $350.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you. Any uh out of pocket?
[AGENT][NEUTRAL] No, this is a secondary, so it picks up in the out of pocket from the primary.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Thank you. And do, does this patient have any coinsurance?
[AGENT][NEUTRAL] No.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] Thank you. And in regards of prior authorization, I have some quotes. I don't know if this is um with you or another department to check if prior authorization is required.
[AGENT][NEUTRAL] No pre-authorization is required.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And it can, um, this is for an echo. I don't know if this can be considered a service that's covered by medical necessity.
[AGENT][NEUTRAL] Yeah, it would fall under their outpatient benefits.
[CUSTOMER][POSITIVE] Perfect, thank you very much. Um, that will be it. Uh, you said you know with Sarah, is it with an H at the end?
[AGENT][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] OK perfect and lastly, do you have a reference number?
[AGENT][NEUTRAL] Call references my name with my last initial than today's date. My last initial is T as in Tom, and then today's date [PII].
[CUSTOMER][POSITIVE] Perfect thank you so much hope you have a good one.
[AGENT][NEUTRAL] You too bye bye.
[CUSTOMER][NEUTRAL] Bye.