AccountId: 011433970860
ContactId: 23e08d4e-c380-4fe8-ad6b-9603ebd60138
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 498489 ms
Total Talk Time (AGENT): 118635 ms
Total Talk Time (CUSTOMER): 143207 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/23e08d4e-c380-4fe8-ad6b-9603ebd60138_20250213T17:16_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, yeah, I need to verify eligibility on a patient and see if their procedure needs a prior authorization.
[AGENT][NEUTRAL] OK, I can verify that for you. And you say you're calling to verify eligibility, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and your name is?
[CUSTOMER][NEUTRAL] My name is [PII], last initial [PII]
[AGENT][POSITIVE] Awesome. And Miss [PII], what's that policy number, please?
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEGATIVE] Sorry, give me just a second, I'm on the wrong tab.
[AGENT][NEUTRAL] You're fine.
[CUSTOMER][NEUTRAL] It is 02286033.
[AGENT][NEUTRAL] Thank you, ma'am. Let's see. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][POSITIVE] Awesome. Let's see. And the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK, I'm showing his effective date is [PII] and he is active.
[CUSTOMER][NEUTRAL] OK awesome and then um I just need to check and see if the uh procedure needs a prior authorization.
[AGENT][NEUTRAL] I don't believe prior authorization is required, uh, but to verify that you will have to contact uh web TPA and I can verify or I can give you their phone number or transfer you over to them.
[CUSTOMER][NEUTRAL] Yeah, if you could transfer me and then before you do, can I get a reference number for our call?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, we don't give reference numbers. You may use my name at today's date.
[CUSTOMER][NEUTRAL] And your first name is?
[AGENT][NEUTRAL] [PII], last initial [PII].
[CUSTOMER][POSITIVE] Perfect thank you so much.
[AGENT][NEUTRAL] You're welcome. One moment, please.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] 458.
[CUSTOMER][NEUTRAL] Welcome to Web TPA, the administrator for the limited benefit health insurance program underwritten by American Public Life Insurance Company. If this is an emergency, please hang up and dial [PII]. If you are a member calling about your premium billing or need to make changes to your account, such as an address change.
[AGENT][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Due to severe winter weather, you may experience longer wait times. If this is not an urgent matter, please call back at a later date. Thank you for your patience.
[CUSTOMER][NEUTRAL] Please note, your call may be monitored or recorded for quality assurance. The information provided during this call is only a description of benefits and is not a guarantee of payment. Benefits are based upon eligibility at the time services are rendered and all plan provisions.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Thank you for calling customer service. This is [PII]. May I have the member's ID number, please?
[AGENT][NEUTRAL] Hi, Ms. [PII]. It's 02286033.
[CUSTOMER][NEUTRAL] OK, you said 02286033. What is the name of the patient?
[AGENT][NEUTRAL] Uh, this patient. Give me a moment.
[AGENT][NEGATIVE] Uh, sorry, I wasn't prepared.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Uh, the patient's name is [PII]. The date of birth is [PII].
[CUSTOMER][POSITIVE] Thank you, give me one moment, his information is loading.
[CUSTOMER][NEUTRAL] Uh, wow, his in from.
[AGENT][POSITIVE] Well, I, um, oh, I'm sorry.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] And I was gonna say I'm calling from APL and I have the provider on the other line and she was inquiring if there was a pre-cert or prior authorization is required.
[AGENT][NEUTRAL] And I didn't know, so I just wanted to verify that with y'all.
[CUSTOMER][NEUTRAL] OK, what is your name?
[AGENT][NEUTRAL] Uh my name is [PII], last initial [PII]
[CUSTOMER][POSITIVE] Thank you and you are with APO and OK so with this plan, no pre-authorization needed.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK. Is that with all of the policies or just certain policies?
[CUSTOMER][NEUTRAL] This is for the APL correct.
[AGENT][NEUTRAL] Mhm. Yes, ma'am. OK, I didn't think so, but I didn't want to tell her no and there was.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] OK, well, I appreciate you so much. um, and you have a great day.
[CUSTOMER][POSITIVE] You're welcome you too bye.
[AGENT][NEUTRAL] Bye.