AccountId: 011433970860
ContactId: 214cb86e-3097-4135-8dfa-4a26a8ef76b7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 241429 ms
Total Talk Time (AGENT): 128636 ms
Total Talk Time (CUSTOMER): 71118 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/214cb86e-3097-4135-8dfa-4a26a8ef76b7_20250527T17:46_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] How you doing, Ms. [PII]? My name is [PII] and I'm calling from LCMC Authorizations calling to check to see um if this patient is still eligible for be well still eligible for benefits.
[AGENT][NEUTRAL] OK, so you want to.
[CUSTOMER][NEUTRAL] And can I get your last name initial?
[AGENT][NEUTRAL] Yes, and what is yours? I only heard [PII]. Mhm.
[CUSTOMER][NEUTRAL] [PII], I apologize.
[AGENT][NEUTRAL] Thank you. And so [PII], you're needing to get eligibility only, is that correct?
[CUSTOMER][NEUTRAL] Well, I need to know, uh, and also if a prior op is needed for this patient upcoming procedure.
[AGENT][NEUTRAL] OK, so eligibility and whether prior authorization is required, is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am, I have the codes.
[AGENT][NEUTRAL] Yes, ma'am. I, I can help you with that. And what is your callback number, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And what is the member's policy number, please?
[CUSTOMER][NEUTRAL] 182301.
[AGENT][NEUTRAL] 182301, is that what you said? I'm sorry.
[CUSTOMER][NEUTRAL] 010 I mean it's 01823301.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you one moment please.
[AGENT][NEUTRAL] And any information that I do provide for you, [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] [PII], [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] And what was your last name initial?
[AGENT][NEUTRAL] Yes
[CUSTOMER][POSITIVE] Alrighty.
[AGENT][NEUTRAL] OK, and again, any information provided will be a verification of benefits and not a guarantee of payment. I do show that he is the spouse of the subscriber on the supplemental policy, and this supplemental policy, [PII] is active. The effective date on the plan is [PII].
[AGENT][NEUTRAL] And because it is a supplemental policy to their primary insurance, there is no prior authorization required.
[AGENT][NEUTRAL] With APL.
[CUSTOMER][NEUTRAL] Alrighty, are the codes, so would you be able to, I'm sorry, you can go.
[AGENT][NEUTRAL] Now, when the claim
[AGENT][NEUTRAL] OK, so when, because it is a supplemental policy, when the claim is submitted to us for review, we must also receive a copy of the primary insurance company's explanation of benefits for review.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Alrighty.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] Once we have processed our claim here at APL, we do have a portal that you can check claim status in and our website for that is located at secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Alrighty and quick question, could you tell me if you all are in network with um.
[CUSTOMER][NEUTRAL] With the facility East Jefferson Hospital?
[AGENT][NEUTRAL] There is no network also with this supplemental policy. It follows his primary.
[CUSTOMER][POSITIVE] Got you. So a second, alrighty, thank you so much. I do appreciate you. Could you give me an uh um call reference number for this call?
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Sure, you would use my name along with today's date.
[CUSTOMER][POSITIVE] Thank you so much you have a great day.
[AGENT][POSITIVE] Oh, you're welcome, [PII]. Yes, ma'am. I hope you do too, and if that is all I can help you with, thank you again for calling APL.
[CUSTOMER][POSITIVE] You too as well. You have a great day.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.