AccountId: 011433970860
ContactId: 3cf061b6-ba1e-423b-ad2b-d58ac6f7f339
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 483230 ms
Total Talk Time (AGENT): 154685 ms
Total Talk Time (CUSTOMER): 181024 ms
Interruptions: 2
Overall Sentiment: AGENT=1.9, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/18/3cf061b6-ba1e-423b-ad2b-d58ac6f7f339_20250318T15:59_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello [PII]. My name is [PII], and I'm calling from Bon Secure Saint Francis East Side facility from authorization specialist department, and I called regarding to check on the member's eligibility and benefits and also the authorization requirements information.
[AGENT][POSITIVE] It would be my pleasure to assist you with that information, [PII]. What is the callback number?
[CUSTOMER][NEUTRAL] Yes, my direct phone number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] That to me?
[AGENT][NEUTRAL] Thank you, [PII], and what is the policy number for the patient, please?
[CUSTOMER][NEUTRAL] Yes, so the policy number I have 60801.
[AGENT][NEUTRAL] That is our payer ID number. Do you have the policy certificate number available?
[CUSTOMER][NEUTRAL] Um, one moment, uh, sorry about that. My software, the member ID information shows that the only information I have. One moment, I will check the, uh, insurance ID card information.
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] One moment, please. Uh
[AGENT][POSITIVE] Take your time.
[CUSTOMER][NEUTRAL] Um, sorry, I don't have that number ID information. Can I provide the member's name and date of birth information if you work with?
[AGENT][NEUTRAL] Yes, sir. What's, absolutely. What's the last name of the patient?
[CUSTOMER][NEUTRAL] Yes, the last name is uh [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII] yeah, go ahead please.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, go ahead. I'm sorry.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Oh sorry about that. Yes, it's [PII]
[AGENT][POSITIVE] Thank you, [PII], and the first name, please?
[CUSTOMER][NEUTRAL] Yes, the first name is uh [PII].
[AGENT][NEUTRAL] Is that [PII] or [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is [PII]'s date of birth, please, sir?
[CUSTOMER][NEUTRAL] Yes, my date of birth is [PII].
[AGENT][NEUTRAL] Thank you, [PII]. [PII], I do have his policy pulled up. Would you like
[AGENT][NEUTRAL] To have his correct policy number?
[CUSTOMER][NEUTRAL] Yes, I'm ready for the policy number information.
[AGENT][NEUTRAL] It is 259.
[AGENT][NEUTRAL] 7159.
[CUSTOMER][NEUTRAL] 259-715-9, correct?
[AGENT][NEUTRAL] Yes, sir, that's correct, and I can help you with that eligibility for [PII]. I am showing that his policy is active as of [PII].
[AGENT][NEUTRAL] And current, this policy is a secondary policy to his primary insurance.
[AGENT][NEUTRAL] And pre-cert is not required.
[CUSTOMER][NEUTRAL] OK, one moment, uh, for this patient, uh, effective from [PII], correct?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One moment please, um,
[CUSTOMER][NEUTRAL] And may I know the eligibility information out of pocket or deductible information for this patient?
[AGENT][NEUTRAL] Is it for inpatient or outpatient?
[CUSTOMER][NEUTRAL] This is for an outpatient surgery.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] He does have an outpatient benefit of $250 that is a per calendar day benefit, and that is a verification of coverage and not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK, so the $250 for a deductible or out of pocket?
[AGENT][NEUTRAL] That is what we pay toward his deductible or co-insurance of his major medical.
[AGENT][NEUTRAL] So that's the benefit amount.
[CUSTOMER][NEUTRAL] So for this patient.
[CUSTOMER][NEUTRAL] OK, so overall the benefit amount is $250 and there is no um copay, co-insurance and deductible information correct, [PII].
[AGENT][NEUTRAL] Not on this policy. That is correct.
[CUSTOMER][NEUTRAL] OK, um,
[CUSTOMER][NEUTRAL] So the $250 it's considered as overall benefits correct?
[AGENT][NEUTRAL] Can you repeat that?
[CUSTOMER][NEUTRAL] So you provide the $250 so it's related to which amount, uh, can you explain, uh, that dollar amount is could be, uh, out of pocket or, uh, deductible. So that amount is, uh, so for the documentation purpose. So that's the reason I'm asking.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] So that $250 benefit per calendar day is to provide payment for his deductible or co-insurance of his major medical policy.
[CUSTOMER][NEUTRAL] Calendar year for.
[AGENT][NEUTRAL] Per calendar day.
[AGENT][NEUTRAL] So it's a per day benefit. Mhm.
[CUSTOMER][NEUTRAL] Oh, calendar day sorry deductible.
[CUSTOMER][NEUTRAL] Coinsurance for uh major medical policy, correct?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Calendar
[CUSTOMER][NEUTRAL] Calendar day correct?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK, and the patient is effective on uh [PII] currently active.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] And pre-certification is not required for any of the outpatient surgery procedure code correct?
[AGENT][NEUTRAL] That is correct. And all benefits given over the phone is a verification of coverage and not a guarantee of payment.
[CUSTOMER][POSITIVE] Thank you so much, [PII]. Could you please provide me the call reference number?
[AGENT][NEUTRAL] Call reference number is my name and today's date.
[AGENT][NEUTRAL] Did I spell my name for you?
[CUSTOMER][NEUTRAL] [PII] and today's date.
[AGENT][POSITIVE] Yeah, that's correct.
[CUSTOMER][NEUTRAL] Yeah, sure, uh, for the documentation.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you so much [PII]. Thanks for all the information and um uh because I have um some of the procedure, it's like knee surgery, so usually this code it's required authorization, so I would like to reconfirm uh.
[AGENT][POSITIVE] My pleasure.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] For any of the musculoskeletal surgery outpatients, if patient comes outpatient surgery, there is no authorization is required, correct?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] OK, thank you so much, [PII]. Thanks for all the information and have a great rest of your day. Take care.
[AGENT][POSITIVE] My pleasure.
[AGENT][POSITIVE] And thank you for calling EPL. I hope you have a wonderful day, [PII]. It was a pleasure to assist you.
[CUSTOMER][POSITIVE] Thank you so much take care.
[AGENT][POSITIVE] Take care. Bye bye.
[CUSTOMER][NEUTRAL] Bye now.