AccountId: 011433970860
ContactId: 2df1bd9b-d063-4c61-a015-23eccacc1e1f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 250800 ms
Total Talk Time (AGENT): 101890 ms
Total Talk Time (CUSTOMER): 88115 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/2df1bd9b-d063-4c61-a015-23eccacc1e1f_20250620T17:06_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, hi, [PII], my name's [PII]. I work for a facility. Um, we have a patient coming in for outpatient surgery, and they do have you as a secondary coverage. I just need to, uh, verify the benefits and preser requirements.
[AGENT][NEUTRAL] Alright, um, OK, can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Uh, sure, direct line is [PII], and there's no extension with that.
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Um, I have 02462885.
[AGENT][NEUTRAL] Alright, let me check.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth for me, please?
[CUSTOMER][NEUTRAL] Uh yeah, I have [PII] with two Ns and birthday is [PII].
[AGENT][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] Alright, I'm showing that this policy is active with an effective date of [PII]. And let me check on those outpatient benefits for you. Just give me a moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] Right, and this is just a verification of benefits, not a guarantee of payment. I'm showing that they have an outpatient benefit maximum of $7500 per person per calendar year, with a maximum of $15,000 per calendar year for all covered persons combined.
[AGENT][NEUTRAL] With a $0 outpatient deductible.
[AGENT][NEUTRAL] And I'm sorry, did you say um.
[AGENT][NEUTRAL] If it was for physical therapy or was it just to be seen?
[CUSTOMER][NEUTRAL] Oh, it's for outpatient surgery. So it looks like surgery is on the, yes, ma'am, [PII].
[AGENT][NEUTRAL] Surgery?
[AGENT][NEUTRAL] Oh, it does have um a surgery benefit as long as the surgery is in a hospital outpatient facility or freestanding outpatient surgery center.
[CUSTOMER][POSITIVE] Perfect. Yes, we are outpatient hospital or hospital outpatient.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Um, so the 7500 and the 150,000 is this more like a.
[CUSTOMER][NEUTRAL] Out of pocket?
[AGENT][NEUTRAL] This is
[AGENT][NEUTRAL] This is secondary gap insurance. So, um, this helps pick up their co-deductible co-insurance and uh co-pay, um, from the primary.
[CUSTOMER][NEUTRAL] Oh, OK. So when you say 7500 for like per person, that's what you'll do towards this.
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] After they've paid, of course, the primary, OK, and then um as far.
[AGENT][NEUTRAL] Right, and we will need the primary EOB um in the claim.
[CUSTOMER][NEUTRAL] Got you OK um and then so and as far as like off requirements I guess you just follow whatever they follow?
[AGENT][NEUTRAL] Correct, yeah, we don't need any pre-authorization or we're not in and out of network. It's, it's based off of their primary insurance.
[CUSTOMER][NEUTRAL] Like the rule.
[CUSTOMER][POSITIVE] Perfect. OK.
[CUSTOMER][POSITIVE] Awesome. Well, that is what I needed to know. um, I know you said your name. I'm so sorry, but, uh, could you give me your name and then a reference number?
[AGENT][NEUTRAL] It's OK.
[AGENT][NEUTRAL] Yeah, so we don't have call reference numbers, but you can use my name and last initial in today's date. So it's [PII] and then today's date.
[CUSTOMER][POSITIVE] [PII] perfect thank you so much.
[AGENT][POSITIVE] OK, thank you for calling APL. I hope you have a great weekend.
[CUSTOMER][NEUTRAL] You too bye bye.