AccountId: 011433970860
ContactId: 3fd8d467-f21f-46a7-b174-145409a4b3da
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 270320 ms
Total Talk Time (AGENT): 161898 ms
Total Talk Time (CUSTOMER): 53221 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/11/3fd8d467-f21f-46a7-b174-145409a4b3da_20250611T17:57_UTC.wav
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[AGENT][POSITIVE] Thank you for contacting APO. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I can barely hear you.
[AGENT][NEUTRAL] OK, can you hear me better now?
[CUSTOMER][NEUTRAL] Did you say your name is [PII]?
[AGENT][NEUTRAL] Yes, my name is [PII] and I'm with HTL. How may I help you?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Uh, I still can barely hear you, but my name is [PII], and I'm calling from pre-certifications at Covenant Medical Center. Is this a medical insurance?
[AGENT][NEUTRAL] Yes, we do have medical insurance. [PII], is there any particular policy that I could look up for you?
[CUSTOMER][NEUTRAL] Yes, the members coming to us for EGD, and I wanted to know if authorization's required. Do you want the ID or the member's name?
[AGENT][NEUTRAL] OK, I can
[AGENT][NEUTRAL] Uh, well, the ID it might begin with a 01 or 02.
[CUSTOMER][NEUTRAL] 02635531
[AGENT][NEUTRAL] 31. OK, thank you. I'm sorry, was that, I, I'm sorry, I heard something in the background and I just wanna make sure that I, uh, that, um, I heard this properly. You said 02632231. Does that sound right?
[CUSTOMER][NEUTRAL] No, 0263.
[AGENT][NEUTRAL] OK, do you mind telling me again?
[AGENT][NEUTRAL] OK, I'm sorry, 0263.
[CUSTOMER][NEUTRAL] 553 1.
[AGENT][NEUTRAL] 5531. OK, thank you. I'm sorry, I don't know what.
[AGENT][NEUTRAL] It just sounds like static there for a second. OK, and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Yeah, I can't really understand you.
[CUSTOMER][NEUTRAL] Um, [PII] [PII].
[AGENT][NEUTRAL] Thank you. Is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] I appreciate that thank you. um, [PII], this policy is a hospital indemnity policy. It went into effect on [PII]. It is active. Now you mentioned wanting to know about pre-authorization or pre-certification that is not required on these policies. This is a limited benefit hospital indemnity policy. It pays the flat rate benefit for the services that are covered and so, um.
[AGENT][NEUTRAL] It does not require pre-authorization and there is no network, uh, uh, providers that they can use so they can go to any network or any providers that they want to pay the flat rate benefit and there's no pre-certification that is required.
[CUSTOMER][NEUTRAL] Can you tell me if it's a covered benefit?
[AGENT][NEUTRAL] I can certainly do that. And what is the uh what is it that we're looking at um.
[CUSTOMER][NEUTRAL] And EGD
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me just check here and see.
[AGENT][NEUTRAL] Is this, is this inpatient, would this be inpatient or would be outpatient?
[CUSTOMER][NEUTRAL] Outpatient hospital.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so we have a surgery benefit, um, as I mentioned before, it will, um, what it does is it, uh, pays for certain very specific services. Uh, we do have a, um, an inpatient benefit for outpatient benefits, uh.
[AGENT][NEUTRAL] What we would have um.
[AGENT][NEUTRAL] There's an outpatient benefit of $500 per calendar day. Uh, that is just a verification of benefits, not a guarantee of payment. They have one day of that.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] If it's outpatient in a physician's office, uh, that is also covered, uh, but that is, that is what this does that, uh, um, it has uh a very limited benefits, uh, for the, for the services. So if, if it's going to be covered, it would be covered, um, either, uh, in the physician's office or outpatient uh hospital.
[AGENT][NEUTRAL] Uh, services.
[CUSTOMER][NEUTRAL] So it is, it is covered for outpatient hospital.
[AGENT][NEUTRAL] Well, it's the only thing that I can tell you is the outpatient hospital services are covered.
[AGENT][NEUTRAL] So I, there's no way for me to, yeah, that's the only, that's the only thing I'd be able to tell you, um, [PII], I'm sorry.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Well thank you for your help.
[AGENT][POSITIVE] OK, well, there's nothing else I can help with and thank you very much for contacting ATO.