AccountId: 011433970860
ContactId: 3a15ebaa-408d-4c05-bd55-82d4ec567418
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 223119 ms
Total Talk Time (AGENT): 102883 ms
Total Talk Time (CUSTOMER): 68155 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/3a15ebaa-408d-4c05-bd55-82d4ec567418_20250502T14:26_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII]. I'm calling from Seattle Jaw Surgery. I was calling to verify medical benefits for a patient and check and see if prior authorization is required.
[AGENT][NEUTRAL] OK, I can verify benefits for you, Ms. [PII], and what is that policy number, please?
[CUSTOMER][NEUTRAL] Uh, policy number is 02614880.
[AGENT][NEUTRAL] OK, thank you. Give me one moment. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] OK, and the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII] and his date of birth is [PII].
[AGENT][POSITIVE] OK, thank you so much. And you say you're calling to verify benefits, correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, I'm showing his effective date is [PII], and he is active on the policy. And what uh specific benefits are you needing?
[CUSTOMER][NEUTRAL] Um, orthoathic surgery.
[CUSTOMER][NEUTRAL] Outpatient
[AGENT][NEUTRAL] Is this for the facility or for the surgeon's charge?
[CUSTOMER][NEUTRAL] For the surgeon.
[AGENT][NEUTRAL] Uh, let's see, give me one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, um, not a guarantee of payment, just verification of coverage. Uh, what type of policy this insured has is a limited indemnity plan, so prior authorization is not required and it doesn't cover for outpatient, uh, facility.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] As far as, um, but they do have a surgical benefit and not a guarantee of payment, just verification and coverage. The max payable for a surgery if performed in a facility is up to $1000 once per year if performed in a um
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If performed in a physician's office or clinic, it pays up to 250.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] 2 minutes.
[CUSTOMER][NEUTRAL] In physician office.
[CUSTOMER][NEUTRAL] And did you say um if it it's performed in the facility there's no coverage for those charges for the facility fees?
[AGENT][NEUTRAL] Not for the facility, but it does cover for the actual surgery if performed in the outpatient facility. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and you said no prior off required, um, and does he have any type of copay or um deductible or anything like that to meet?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Uh, no, ma'am. Uh this type of policy is an indemnity plan. There's no deductible or co-pay under the plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] All right, that's what I need. Can I get a reference number?
[AGENT][NEUTRAL] Uh, yes, ma'am. If you like, you may use my name in today's date.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and it's [PII] last initial [PII].
[CUSTOMER][POSITIVE] OK, and then today's 8, got it. Thank you very much. I appreciate your help, [PII].
[AGENT][POSITIVE] You are welcome, Miss [PII] and thanks for calling APL.
[CUSTOMER][POSITIVE] All right have a good day.
[AGENT][NEUTRAL] You too and have