AccountId: 011433970860
ContactId: 207740d4-175a-42b5-b941-c076e14fac2a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 171750 ms
Total Talk Time (AGENT): 77321 ms
Total Talk Time (CUSTOMER): 67813 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/207740d4-175a-42b5-b941-c076e14fac2a_20250326T15:42_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] I'm sorry, I didn't catch your name in the beginning.
[AGENT][NEUTRAL] Um, it's [PII], um, yes, ma'am.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] How do you spell that?
[AGENT][NEUTRAL] Um, it's [PII].
[CUSTOMER][NEUTRAL] Thank you [PII] so I'm calling to get benefits for outpatient surgery and to see if you require authorization.
[AGENT][NEUTRAL] I'm sure, [PII], I can assist you with benefits. Um, first, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. Now, I need the policy number, please.
[CUSTOMER][NEUTRAL] 01897883
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK. Thank you. And just let me advise you the verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII] and the policy is still active. You said that this was for an outpatient um surgery center?
[CUSTOMER][NEUTRAL] Well, we're billing for the professional but yes it's going to be done at an outpatient ambulatory surgery center.
[AGENT][NEUTRAL] OK, for outpatient, we cover.
[CUSTOMER][NEUTRAL] But we're we bill for the physician, yeah, OK, sorry, go ahead.
[AGENT][NEUTRAL] Yes, ma'am, that'd be covered um all under the outpatient benefit, which covers up to 3500 per calendar year and that's for the co-pay, the co-insurance, and the deductible after the primary insurance processes the claim. And since this is secondary gap insurance, there's no authorization required.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do you show anything that she's used so far of that 3500?
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] Um, so far she hasn't used any, so the full 3500 is available.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Alright thank you I do I just use your name for uh um.
[CUSTOMER][NEUTRAL] Reference number or?
[AGENT][NEUTRAL] Yeah, just my name and today's date.
[CUSTOMER][NEUTRAL] Or is there a reference number?
[CUSTOMER][POSITIVE] OK, alright, OK, thank you so much for your help.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Is there anything else that I can assist you with?
[CUSTOMER][POSITIVE] No, that's it thank you.
[AGENT][POSITIVE] Mhm. Thank you again, [PII], for calling APL. Have a great day. Bye.
[CUSTOMER][NEUTRAL] You too bye.