AccountId: 011433970860
ContactId: 31a1bd9c-0aec-47a1-a975-e028fc90690c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 175619 ms
Total Talk Time (AGENT): 78185 ms
Total Talk Time (CUSTOMER): 79271 ms
Interruptions: 1
Overall Sentiment: AGENT=2, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/21/31a1bd9c-0aec-47a1-a975-e028fc90690c_20250321T14:21_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from an OBGYN office to see um benefits for a surgery for one of our patients.
[AGENT][POSITIVE] OK, sure, I can assist you with benefits, [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] OK, it is 02100349 ML 7.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yes, her name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, perfect. Thank you.
[AGENT][NEUTRAL] All right. And before I give you any benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage and that's a disclaimer. And this is one of our secondary supplemental plans to the major medical.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And with this one.
[AGENT][NEUTRAL] Um, we do not cover anything in office. It has to be outpatient facility.
[CUSTOMER][NEUTRAL] Yes, it would be done at an ambulatory surgical center.
[AGENT][NEUTRAL] OK. All right, so the outpatient maximum, and this is a calendar year maximum of 2500 per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK, so you guys cover up to 2500 for the surgery.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect, um, and then that's it's any surgery, right? I don't need to give you like the specific codes or anything?
[AGENT][NEUTRAL] Uh no. Mm mm, no, because uh we cover outpatient surgery. So it is gonna be based off the major medical and what they apply towards the deductible copayment and insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK perfect yeah because for her other one she has United, so her other one is asking for the the rest of her deductible which is like 4000 something, so those that like 4,000ish that she has remaining, you guys will cover 2500.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mm.
[AGENT][POSITIVE] Correct, mhm.
[CUSTOMER][NEUTRAL] OK, and then do I need to, do I need to send in like a prior authorization or anything like that? No? OK, amazing. And then you said your name was [PII]?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No. Mm.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, and can I get a reference number? OK.
[AGENT][NEUTRAL] We don't have reference numbers you can use my name in today's date.
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][NEUTRAL] Mhm. Is there anything else I can help you with today, Ms. [PII]?
[CUSTOMER][POSITIVE] No, that's it thank you so much.
[AGENT][POSITIVE] OK, you're welcome and thank you for calling APO. Have a good day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you, bye bye.