AccountId: 011433970860
ContactId: 32c52465-7e20-4b2f-9506-248244d910d5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 240059 ms
Total Talk Time (AGENT): 91634 ms
Total Talk Time (CUSTOMER): 95746 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/32c52465-7e20-4b2f-9506-248244d910d5_20250411T19:12_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Oh, hi, [PII]. Good afternoon. My name is [PII]. I'm calling you from Valley Medical Center. Um, I just need to determine if this patient's, um, surgery will be covered and whether that will require prior authorization.
[AGENT][NEUTRAL] Hi.
[AGENT][NEUTRAL] OK. Well, I can take a look at the coverage for you, and may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, um, callback number is gonna be [PII].
[AGENT][NEUTRAL] Oops, hold on, I typed in the wrong spot. Can you repeat that for me, please?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Um, that is 02494078.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And hold on one moment, I'm just pulling the
[AGENT][NEUTRAL] Benefits, but just for the prior author pre-cert, there's no um APL doesn't require any prior author pre-cert because we're not a major medical insurance company.
[AGENT][NEUTRAL] And then in terms of
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The coverage
[CUSTOMER][NEUTRAL] So what does that, I don't know if it will be covered then because it says it's a limited benefit plan.
[AGENT][POSITIVE] Right, I'm looking at the benefits now. I just wanted to answer your question about the prior off, so we don't have to worry about that one, we don't require it, and I'm looking for the benefits now.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] So the policy will pay up to $250 per day with a max of 1 day per calendar year for surgery in a hospital, hospital outpatient facility or freestanding outpatient surgery center.
[CUSTOMER][NEUTRAL] Oh, for outpatient facility surgery, it will pay a maximum of $250.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] I'll call you back. OK, no problem.
[CUSTOMER][NEUTRAL] OK bye
[CUSTOMER][NEUTRAL] Um, OK, so I'm not sure they have Molina as secondary, so I don't know if that will pick it up.
[CUSTOMER][NEUTRAL] 59,820 OK.
[CUSTOMER][NEUTRAL] OK, so, perfect, um, no prior authorization required since this is, what did you call it, a medical?
[CUSTOMER][NEUTRAL] What type of medical plan?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Well, this is a hospital indemnity policy, but the prior author isn't required because we're not a major medical.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] All righty. And then I just need a uh reference call number.
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. And again, that's [PII], first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And [PII], was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] Um, that is it. Thank you so much.
[AGENT][POSITIVE] You're welcome. Well, thank you for calling APL. I hope you have a great weekend.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you. Bye-bye.