AccountId: 011433970860
ContactId: 0f577ae8-c489-4d39-ba7e-aa3d5be80cee
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 257950 ms
Total Talk Time (AGENT): 121880 ms
Total Talk Time (CUSTOMER): 63896 ms
Interruptions: 2
Overall Sentiment: AGENT=1.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/0f577ae8-c489-4d39-ba7e-aa3d5be80cee_20250130T13:19_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] with Saint Elizabeth Healthcare. I'm trying to verify benefits on a patient and then also see if um.
[CUSTOMER][NEUTRAL] A code requires authorization.
[AGENT][NEUTRAL] OK, [PII], so you do not need eligibility. You only need benefits and to find out if prior authorization is required. Is that correct? Yes, ma'am, I can help you with those two things. And what is your callback number, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, [PII]?
[CUSTOMER][NEUTRAL] It is let me find that for you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] 02513078.
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] OK, and any information that I do provide for you today, [PII] will be a verification of benefits and not a guarantee of payment. What is your patient's name please and their date of birth?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so this policy that she has with APL [PII] is not major medical coverage. This is a limited benefit plan. It's a hospital indemnity limited benefit plan. Therefore, there is no prior authorization required.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what type of benefit information do you need? inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Uh, outpatient
[CUSTOMER][NEUTRAL] And she's gonna be having a CAT scan.
[AGENT][NEUTRAL] OK, so let me look to see if, OK.
[AGENT][NEUTRAL] So she probably, I'm sorry, go ahead. No, no, no, go ahead.
[CUSTOMER][NEUTRAL] Is she, do you, do you know, I'm sorry, do you know.
[CUSTOMER][NEUTRAL] Um, I just wanna make sure that she's still eligible too, I guess.
[AGENT][NEUTRAL] So you do need eligibility? OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So yes, this plan is still showing as active with an effective date of [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so one moment.
[AGENT][NEUTRAL] OK. So on this policy, she does have a diagnostic testing benefit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And for this benefit on this plan.
[AGENT][NEUTRAL] The benefit amount is $100 per day, and a maximum of 2 days per calendar year per cover person.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Alrighty, I think that's all that I needed.
[AGENT][NEUTRAL] OK, well, if that's all then that I can help you with, oh, and just one last thing, once we process the claim, [PII], we do have a portal in which you should be able to claim, excuse me, check claim status, and our portal website is secured. [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] OK, and I'm sorry, what was your name?
[AGENT][NEUTRAL] [PII], and my name and today's date will be your call uh reference number for today.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK perfect thank you so much [PII].
[AGENT][POSITIVE] OK, well, you're very welcome. So thank you again for calling APO and I hope you have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.