AccountId: 011433970860
ContactId: 11b0b90d-a655-4a7c-b078-8fea869e8f08
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 733450 ms
Total Talk Time (AGENT): 238390 ms
Total Talk Time (CUSTOMER): 226481 ms
Interruptions: 4
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/11b0b90d-a655-4a7c-b078-8fea869e8f08_20250411T12:51_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 [PII], my name is [PII]. My initial [PII].
[CUSTOMER][NEUTRAL] I'm calling from uh Bon Saint Francis Downtown Hospital facility.
[AGENT][POSITIVE] Yes, sir. And how can I help you today, [PII]?
[CUSTOMER][NEUTRAL] Uh, I have a patient, uh, this patient is scheduled for outpatient surgery.
[CUSTOMER][NEUTRAL] This patient has been scheduled for hospital outpatient surgery. I want to check whether this patient has surgery benefit or not. I have the patient's name, date of birth, member ID with me.
[AGENT][NEUTRAL] OK, [PII], so you're needing to check eligibility and benefits or just eligibility? I mean just benefits. I'm sorry.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] I, I need all the information eligibility benefit and decision.
[AGENT][NEUTRAL] Yes sir, I can help you with eligibility and benefits and what is your callback number, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] that is my direct number, no extension.
[AGENT][NEUTRAL] Thank you. And the patient's policy number?
[CUSTOMER][NEUTRAL] 026
[CUSTOMER][NEUTRAL] 4909.
[AGENT][POSITIVE] Thank you one moment please.
[AGENT][NEUTRAL] OK, you said 026. Well, give me that number again because that wasn't enough numbers according to what I heard.
[CUSTOMER][NEUTRAL] OK. 026.
[CUSTOMER][NEUTRAL] 4909.
[AGENT][NEGATIVE] OK, so that's not enough that's not enough uh numbers.
[AGENT][NEGATIVE] That's not a valid policy number.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, D as in David 437.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] 33011.
[AGENT][NEUTRAL] OK. Now, that is not a bad, that is for 90 degree benefits. Do you have a copy of the ID card, [PII]?
[CUSTOMER][NEUTRAL] Yes, I have the copy of that. I I have the copy of the ID card. It shows 02604909.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] OK, so you were missing one of the numbers that you had given me the first two times. You were giving me 0264909. So after the 6th, there should be a 0. So just one moment.
[CUSTOMER][NEUTRAL] Oh, I see.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] And any information that I provide for you today, [PII] will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] [PII], uh, date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] [PII] date of birth is [PII].
[AGENT][NEUTRAL] Yes, and he is a subscriber on this limited benefit plan. It is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you were needing to know for benefits for outpatient.
[AGENT][NEUTRAL] Surgery?
[CUSTOMER][NEUTRAL] Uh yes. Uh, this patient is scheduled for, yeah, this patient is scheduled for hospital outpatient surgery.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] you know.
[CUSTOMER][NEUTRAL] I just.
[AGENT][NEUTRAL] Let me get the benefits pulled in, please.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] One moment while some information is loading for me.
[CUSTOMER][POSITIVE] OK take your time.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] It's still loading some information for me, so please bear with me, [PII].
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] not
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so this policy, this is a limited benefit plan and it does, um, so it's not major medical insurance. There are surgery benefits. The max benefit is $1000.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] On this plan.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh, this patient does not have surgery benefit, right? No surgery benefit. Am I correct?
[AGENT][NEUTRAL] I just explained that the surgical benefit, the mask would be $1000.
[CUSTOMER][NEUTRAL] Oh, I see.
[CUSTOMER][NEUTRAL] OK. Uh, the policy is still active from [PII].
[AGENT][NEUTRAL] Hi.
[AGENT][NEUTRAL] It is. The policy is that.
[CUSTOMER][NEUTRAL] There is no termination date. Am I correct? OK.
[AGENT][NEUTRAL] No termination date.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And once the claim has been processed.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] We also have a portal in which you should be able to check claim status. [PII] by going to [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Yes,
[CUSTOMER][NEUTRAL] OK. Uh, this patient has a limited benefit. Uh, surgery cost will be.
[CUSTOMER][NEUTRAL] Limited benefit that that is $1000 more than $1000 it it be patient responsibility, am I correct?
[AGENT][NEUTRAL] We do not determine patient responsibility, that would be up to the provider.
[AGENT][NEUTRAL] And this policy does have anesthesia benefits, which would be calculated on a percentage based on the, on the surgery that is performed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, uh, no, my question is whether this patient has surgery benefit that the surgery will cover under this member plan.
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] Yes, sir, I
[AGENT][NEUTRAL] Yes, sir, and I already explained what the maximum benefit was.
[CUSTOMER][NEUTRAL] Oof
[CUSTOMER][NEUTRAL] Maximum benefit is $1000 right?
[AGENT][NEUTRAL] Yes, sir. That is correct. And the anesthesia benefit amount would be 25% of the surgical benefit amount up to the maximum benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have a CPT code. I want to check whether authorization is cured or not.
[AGENT][NEUTRAL] There would be no prior authorization required on this policy since it is not major medical insurance, prior authorization is not required.
[CUSTOMER][NEGATIVE] OK, uh, you told that this is not medical insurance, so appreciation is not OK for the subject. Am I correct?
[AGENT][NEUTRAL] I'm sorry, uh, your voice is breaking up. What did you ask?
[CUSTOMER][NEUTRAL] Appreciation is not, right?
[AGENT][NEUTRAL] Operation is not covered? Is that what you asked?
[CUSTOMER][NEUTRAL] No, no, uh, this patient is scheduled for surgery. I want to check whether, uh, authorization is required or not for the CPT code.
[AGENT][NEUTRAL] You're wanting to check a CPT code to see if.
[CUSTOMER][POSITIVE] Prayer appreciation.
[AGENT][NEUTRAL] If it's for prior authorization, we need prior authorization, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, and as I explained to you, there is no, no, yes, no prior authorization is required.
[CUSTOMER][NEUTRAL] Yes, yes, I want to check with other issues.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I study co-pay co-insurance will be applied?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No there is not because this is not major medical insurance. It is a limited benefit plan.
[CUSTOMER][NEUTRAL] Uh, your name please?
[AGENT][NEUTRAL] Again my name is [PII] and you would use my name along with today's date as your call reference number.
[AGENT][NEUTRAL] And is there anything else?
[CUSTOMER][NEUTRAL] Uh, please spell your name.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Could you spell yours?
[CUSTOMER][NEUTRAL] Uh [PII], right?
[AGENT][NEUTRAL] No, sir, there's no E and there's no Y. It's [PII]
[CUSTOMER][NEUTRAL] [PII] first initial of the last name [PII].
[AGENT][NEUTRAL] S
[CUSTOMER][NEUTRAL] OK, uh, call reference number, your name and today's date, right?
[AGENT][POSITIVE] That's correct, yes, sir.
[CUSTOMER][NEUTRAL] T R A
[CUSTOMER][NEUTRAL] 9 S as in Sierra [PII]. The time is [PII] Eastern Standard Time.
[CUSTOMER][NEUTRAL] Uh my name is [PII]
[AGENT][POSITIVE] OK, thank you. Yes.
[AGENT][POSITIVE] All right. Well, thank you very much, [PII] and again, if that is all I can help you with, thank you for calling APL and I hope that you have a very nice day.
[CUSTOMER][NEUTRAL] Hi
[CUSTOMER][POSITIVE] Thank you bye.
[AGENT][NEUTRAL] Uh-huh. Bye-bye.