AccountId: 011433970860
ContactId: 20f5bc01-65e3-4f62-b3f9-e6d37da793cc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 173520 ms
Total Talk Time (AGENT): 103577 ms
Total Talk Time (CUSTOMER): 49363 ms
Interruptions: 1
Overall Sentiment: AGENT=2.4, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/20f5bc01-65e3-4f62-b3f9-e6d37da793cc_20250520T15:14_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] What was your name again?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] How do you spell that?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] All right, my name is [PII] and I'm with Doctor [PII]'s office.
[CUSTOMER][NEUTRAL] And I'm calling to check on a prior authorization for a code to see if it requires prior authorization and is it a covered benefit.
[AGENT][POSITIVE] OK, I'll be glad to help you, [PII]. Go and give me a good policy number.
[CUSTOMER][NEUTRAL] It is 126-5692.
[AGENT][POSITIVE] All right, [PII], thank you so much for that information. Now while I'm pulling this up, go ahead and give me a good return telephone call number please, ma'am.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Alrighty, [PII], thank you so much for all that information. Now, your patient's name and date of birth today please, ma'am?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Alrighty, [PII], thank you so much for all of that information. It looks like [PII] is the insured on this medical supplemental plan. I do show his original effective date is [PII]. He is current and active, but I must advise that verification of coverage is not a guarantee of payment on a claim, but you did say you want benefits. Is that correct?
[CUSTOMER][NEUTRAL] Yeah, I need to find out if a uh procedure code requires prioritization through your company.
[AGENT][NEUTRAL] Where, where is she gonna have it done at?
[CUSTOMER][NEUTRAL] He's gonna have it done outpatient hospital.
[AGENT][NEUTRAL] OK, let me get over to that benefit. Now of course what we are is his medical supplemental plan. So the only thing we would pick up on is anything for sickness and injury that is applied towards his deductible copay or co-insurance at his primary insurance carrier. Nothing here for routine is covered here, no matter what. That has outpatient benefit here is no precert for anything.
[AGENT][NEUTRAL] He has a $250 deductible per calendar year.
[AGENT][NEUTRAL] And it outpatient max is $4750 payable per calendar year outpatient benefit.
[CUSTOMER][POSITIVE] Alright, thank you so much. Do you do reference?
[AGENT][NEUTRAL] Well, yes, ma'am. Is that all I can help you with? Go ahead.
[CUSTOMER][NEUTRAL] Yeah, you do reference uh call numbers?
[AGENT][NEUTRAL] No, we don't give reference number, [PII], but you can use my name in today's date, and is that all that I can help you with?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Yes, that's it thank you.
[AGENT][POSITIVE] All [PII], [PII]. Yes, ma'am, and thanks for calling APO. Have a great day.