AccountId: 011433970860
ContactId: 233fe624-ac89-4fea-a255-2d6f162f5f96
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 218250 ms
Total Talk Time (AGENT): 116408 ms
Total Talk Time (CUSTOMER): 56934 ms
Interruptions: 0
Overall Sentiment: AGENT=1.8, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/233fe624-ac89-4fea-a255-2d6f162f5f96_20250409T15:02_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I have a patient getting an outpatient surgery at an ambulatory surgical center, and I just wanted to see if it is covered under their plan and then get the benefits.
[AGENT][POSITIVE] OK, I'm happy to check on benefits today. What is the patient policy number?
[CUSTOMER][NEUTRAL] It's 02456565.
[AGENT][POSITIVE] OK, thank you for that.
[AGENT][NEUTRAL] And then if you don't mind, can I grab your first name and a callback number?
[CUSTOMER][NEUTRAL] Yeah it's [PII] and it's [PII].
[AGENT][NEUTRAL] Thank you. And then what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII] [PII].
[AGENT][POSITIVE] All right, thank you so much.
[AGENT][NEUTRAL] So the patient is active. The effective date on here is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let's see, I'm just pulling this policy here. The member has a limited benefit plan, so, um, it's a hospital indemnity plan. It's just gonna pay a set amount depending upon what they're being seen for, so.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see here.
[CUSTOMER][NEUTRAL] Let's see here.
[CUSTOMER][NEUTRAL] And it will be um outpatient at an ambulatory surgical center and it's cataract surgery.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see if there's anything.
[AGENT][NEUTRAL] OK, I checked exclusions. I don't see anything that states anything about eyes, so I don't think that that's gonna be any sort of issue. Um, this is verification of benefits, of course, not guarantee of payment. The surgical benefit on the plan, uh, is up to $1000. So the plan will pay $1000 towards a surgical schedule, uh, nothing additional.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] It does have an outpatient uh maximum benefit for any sort of like office visits. They're allowed $5 per calendar year and there is a benefit amount of $75 towards that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Perfect and then does it need preauthorization?
[AGENT][NEUTRAL] No, no pre-op is needed. No.
[CUSTOMER][POSITIVE] Perfect. Alright, so pretty much they'll pay up to $1000.
[AGENT][POSITIVE] Yes, ma'am, that is correct.
[CUSTOMER][NEUTRAL] And is that per visit just because they have to go back 2 times for each eye?
[AGENT][NEUTRAL] Um, let's see.
[AGENT][POSITIVE] Correct. That would be per surgery, yes.
[CUSTOMER][POSITIVE] For sure perfect. Alright, and [PII], can I get a reference number from you please?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, absolutely. [PII]. Call reference is gonna be my name with my last initial than today's date. My name again is [PII], which is [PII] Last initial is [PII].
[CUSTOMER][POSITIVE] Perfect thank you so much I appreciate your help.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][NEUTRAL] You as well bye bye.
[AGENT][NEUTRAL] Bye.