AccountId: 011433970860
ContactId: 255081e9-2910-4dfc-ab88-3a685a1bcf99
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 157960 ms
Total Talk Time (AGENT): 84158 ms
Total Talk Time (CUSTOMER): 53222 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/255081e9-2910-4dfc-ab88-3a685a1bcf99_20250204T19:29_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. This is Easy. How can I help you?
[CUSTOMER][NEUTRAL] Um, hi, did you say [PII]? I'm sorry, I didn't hear you very well.
[AGENT][NEUTRAL] Um, EV
[CUSTOMER][NEUTRAL] OK. I have a mutual patient and they have an upcoming nasal sinus surgery, and they have UHC um as a primary insurance and you guys are their secondary. I just have some codes. I need to see if it requires authorization.
[AGENT][POSITIVE] Um, yes, ma'am. I can assist you with benefits. First, could I get your name and a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII], last initial [PII] and [PII].
[AGENT][NEUTRAL] Mm. Thank you, [PII]. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] 01852008
[AGENT][NEUTRAL] OK. Please repeat that policy number.
[CUSTOMER][NEUTRAL] 01852008
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII] [PII]
[AGENT][NEUTRAL] And just let me advise you that verification of coverage does not guarantee payment of claims. Um, let's see. The, the effective date on this policy was [PII]. The policy is still active, and this is secondary gap insurance. Um, there's no authorization required because we go by the primary insurance's guidelines. Um, would this be for inpatient or outpatient benefits?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's outpatient.
[AGENT][NEUTRAL] OK, and under this policy for outpatient, we cover up to $6800 per calendar year and that's for the co-pay, the co-insurance, and the deductible after the primary insurance processes the claim. But there is a $1000 deductible that needs to be met first.
[CUSTOMER][NEUTRAL] OK, all right perfect and do you have a call reference number for me by chance?
[AGENT][NEUTRAL] Um, yes, ma'am. So the reference number, you can use my name and today's date. Um, and my name is [PII]. Um, it's spelled E, V like [PII] and my last initial is [PII]. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] No, that'll be it, [PII]. Thank you so much for your help. I appreciate it. You have a wonderful day.
[AGENT][NEUTRAL] You do the same, [PII]. Thank you for calling ATL. Mm bye.
[CUSTOMER][POSITIVE] Thank you bye bye.