AccountId: 011433970860
ContactId: 49da2c41-f3b8-4a6d-8423-26c671c6f5d2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 143759 ms
Total Talk Time (AGENT): 69177 ms
Total Talk Time (CUSTOMER): 57758 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=1.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/03/49da2c41-f3b8-4a6d-8423-26c671c6f5d2_20250603T12:24_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] I'm sorry you kind of broken up. You said your name is?
[AGENT][NEUTRAL] Um, it's [PII].
[CUSTOMER][NEUTRAL] [PII]. Hi, Ms. [PII]. My name is [PII]. I'm calling from um MUSC Medical University of South Carolina.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] We have a a member here who's listed you guys as a secondary insurance for a surgery, a tonsillectomy. Do you guys cover those? And will it require a pre-cert?
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Um, well, first, let me get a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] OK, it's [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII], and yes, ma'am, I can assist you with benefits. Um, could I get the member's policy number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes ma'am, I have 02544097.
[AGENT][NEUTRAL] Can you please verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's A Melody A apostrophe Melody Ralph, date of birth of [PII].
[AGENT][NEUTRAL] OK, thank you. And just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII] and the policy is still active. And this surgery, um, will it take place in a doctor's office or outpatient facility or will she be admitted?
[CUSTOMER][NEUTRAL] Outpatient facility outpatient facilities outpatient, no, no admission.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK. Yes, ma'am. Under this policy, we cover up to $1000 per occurrence. So that's $1000 every 90 days for the co-pay, the co-insurance, and the deductible after the primary insurance processes the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and prior off that's not needed?
[AGENT][NEUTRAL] Um, no, since we're secondary coverage, we go by the primary insurance guidelines, so there's no authorization required.
[CUSTOMER][POSITIVE] Great OK thank you so much I appreciate it.
[AGENT][NEUTRAL] OK. Is there anything else I can assist you with?
[CUSTOMER][POSITIVE] No ma'am, that's all I needed thank you.
[AGENT][POSITIVE] OK, I thank you again, [PII], for calling APL. You have a great day. Mm bye.
[CUSTOMER][POSITIVE] You too be safe bye bye.