AccountId: 011433970860
ContactId: 120d5199-5211-4ad5-8c6f-edb9f49648b9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 388890 ms
Total Talk Time (AGENT): 124021 ms
Total Talk Time (CUSTOMER): 109125 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/120d5199-5211-4ad5-8c6f-edb9f49648b9_20250408T15:36_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], I'm calling to verify members of supplement coverage.
[AGENT][NEUTRAL] OK, I can help you with eligibility of a member. Can I please get your name and your callback number?
[CUSTOMER][NEUTRAL] [PII] phone number [PII].
[AGENT][NEUTRAL] OK, and what is the name of the facility you're calling from, Ms. [PII]?
[CUSTOMER][NEUTRAL] Boca, B O C A R R A T O N, outpatient surgery and laser center.
[AGENT][NEUTRAL] OK, and then may I please get the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] OK. Uh her name is [PII]
[CUSTOMER][NEUTRAL] [PII] Date of birth.
[CUSTOMER][NEUTRAL] [PII] and her
[CUSTOMER][NEUTRAL] ID number.
[CUSTOMER][NEUTRAL] I don't know which one it is outpatient certification number.
[AGENT][NEUTRAL] It could be either the inpatient or the outpatient, yes ma'am.
[CUSTOMER][NEUTRAL] OK, outpatient would be 02036916 ML 8.
[AGENT][POSITIVE] OK, thank you very much. Let me pull up that policy real quick.
[AGENT][NEUTRAL] OK, I do show that Santa does have an active policy. The effective date of the policy is [PII].
[AGENT][POSITIVE] And it is uh still active and current.
[CUSTOMER][NEUTRAL] [PII]. And what are the benefits for outpatient surgery?
[AGENT][NEUTRAL] OK, uh, this is just to verify the benefits. It's not a guarantee of payment. She has an outpatient per calendar day benefit amount of $500 that goes towards deductible, co-pay or co-insurance only.
[CUSTOMER][NEUTRAL] OK, a benefit per day of $500.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and is the surgery center along with the anesthesiologist and the doctor, are they all covered under that $500 benefit?
[AGENT][NEUTRAL] Let me check. I'm gonna pull her policy in and review it to see what it says about um.
[AGENT][POSITIVE] The facil type of facility that can be used?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Just a second while I look it up.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The physician's office.
[AGENT][NEUTRAL] Will not be covered if it's done in an office so it'll have on in an ER urgent care center.
[CUSTOMER][NEUTRAL] Yeah, that's, that's what I'm talking about. Yeah, they're gonna be staying in an outpatient. So, but when it's an outpatient, the doctor is billing the insurance along with the anesthesiologist in the surgery center, so it's 3 people, 3 entities.
[AGENT][NEUTRAL] OK. Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am. So the.
[CUSTOMER][NEUTRAL] So I'm trying to figure out if they're all covered under that, that same mask.
[AGENT][NEUTRAL] OK, let me look um.
[AGENT][NEUTRAL] I'm gonna go back to her policy because it's saying the physician's fee is not covered for outpatient.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Yes, it
[AGENT][NEUTRAL] The surgery, if it's done in an ambulatory center, the treatment.
[AGENT][NEUTRAL] But, but the physician's fee is not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the physician is not covered. What about the anesthesiologist?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Are they covered?
[AGENT][NEUTRAL] No, that would also be considered a physician.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Alrighty thank you.
[AGENT][POSITIVE] OK. You're so very welcome. I hope you have a wonderful day. I, yes, you can use my name [PII] and today's date.
[CUSTOMER][NEUTRAL] Can I have a call reference?
[AGENT][NEUTRAL] Is there anything else I can help you with, Miss [PII] before we go?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, you have a great day.
[AGENT][POSITIVE] You, you too, Miss [PII], thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK bye bye.
[AGENT][NEUTRAL] Bye bye.