AccountId: 011433970860
ContactId: 425d66ad-0deb-4c46-b4d3-4997a4b83051
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 211600 ms
Total Talk Time (AGENT): 111819 ms
Total Talk Time (CUSTOMER): 89120 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/425d66ad-0deb-4c46-b4d3-4997a4b83051_20250127T20:31_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm a nurse with VCU Pediatric Endocrinology. I am trying to get a prior authorization for a patient of ours.
[AGENT][NEUTRAL] OK, I can definitely see if authorization is required. Um, did you say your name was [PII]? I'm sorry.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII], OK, and [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Alright, thank you. Do you have the policy number?
[CUSTOMER][NEUTRAL] I have a policy number of 02444783.
[AGENT][NEUTRAL] OK, thank you. And what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] [PII], last name is [PII], [PII] and [PII]'s date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that, Jie. Uh, so this policy is active. Effective date was [PII], and so this is a secondary medical policy. It is designed to help with co-pay, deductible and co-insurance as long as major medical pays, and this plan is very dependent on major medical, uh, so as long as uh they're willing to pay this policy can, uh, therefore authorization is not required.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, alright, so like her [PII], it would be able to be run through in um pharmacy or no? Does it have to be run through medical?
[AGENT][NEUTRAL] Oh, for
[AGENT][NEUTRAL] Oh, what I'm sorry, uh, for this plan, are you asking about pharmacy coverage for this plan?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, so it would still have to go through their primary first, uh, because this policy can't pay anything out on its own. If major medical will not pay this policy cannot.
[CUSTOMER][NEUTRAL] Yes, OK.
[CUSTOMER][NEGATIVE] OK, because I am getting, um, because when I called the pharmacy about her [PII], they said it was running through insurance but there was $110 that wasn't being covered. Would
[AGENT][NEUTRAL] I see.
[AGENT][NEUTRAL] I see. OK.
[CUSTOMER][NEUTRAL] Would your insurance pick it up then?
[AGENT][NEUTRAL] Let me check to see if this policy offers prescription coverage. Some of them do and some of them don't. Uh, give me just a moment, let me check that. I'm gonna get the policy pulled up here.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, because, because [PII] can be run through medical and it can also be run through pharmacy.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] That's one of the wonderful things about a diabetic medication, you know, a diabetic thing, sensor.
[AGENT][NEUTRAL] Oh yes.
[AGENT][NEUTRAL] No kidding. One of the, one of the few, it seems.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let's see. Give me just a moment.
[AGENT][NEUTRAL] OK. So this plan does not offer any uh prescription drug coverage.
[CUSTOMER][NEUTRAL] OK, all right, um, so if we would run it under medical then this plan could cover some of it?
[AGENT][NEUTRAL] No, uh, so this plan does still have its own, you know, set policy on what it would and would not cover. It's just that the benefits that it does cover would help with those. So like, you know, an outpatient surgery, for example, um, if she were to have that or any of the individuals, it would pick up what major medical does not.
[CUSTOMER][NEUTRAL] No, OK.
[CUSTOMER][POSITIVE] OK, OK, OK, good to know. OK, thank you very much I appreciate your time and help.
[AGENT][NEUTRAL] Yeah, confusing. Was there anything else I can help you with?
[CUSTOMER][POSITIVE] No, that's everything. Thank you so much.
[AGENT][POSITIVE] Alright, yeah, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Thanks you too bye bye.
[AGENT][NEUTRAL] Bye bye.