AccountId: 011433970860
ContactId: 551f37dd-bd3d-4b3e-980d-70e30a84e749
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 356269 ms
Total Talk Time (AGENT): 166308 ms
Total Talk Time (CUSTOMER): 132543 ms
Interruptions: 3
Overall Sentiment: AGENT=1.2, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/551f37dd-bd3d-4b3e-980d-70e30a84e749_20250416T13:15_UTC.wav
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[CUSTOMER][NEGATIVE] That's the thing that uh there's something wrong.
[AGENT][POSITIVE] Good morning. Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Oh yes, good morning [PII]. My name is [PII] calling from the facility. How are you today?
[AGENT][NEUTRAL] I'm fine. I'm so sorry, [PII], could you spell your name for me one more time? I missed part of that.
[CUSTOMER][NEUTRAL] Uh, sure. It is [PII].
[AGENT][POSITIVE] Thank you. OK, and [PII], how can I help you today?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] I am calling to verify member eligibility and see if prior authorization is required for observation admission. It's not been inpatient. It's an observation.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so you're needing to verify eligibility and see if prior authorization or pre-cert is required, is that correct? For an observation stay?
[CUSTOMER][NEUTRAL] Yes, it's required on this plan.
[AGENT][POSITIVE] Yes, I can help you with those things. And [PII], what is a good callback number for you?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] My direct line is [PII].
[AGENT][NEUTRAL] Thank you and what is the member's policy number please?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Uh, it is the letter D as in David, 43302329.
[AGENT][NEUTRAL] OK, thank you. Now, on this, that D number is not the APL number, that is a 90 degree benefit number. Some of the members have dual coverage with APL and 90 degree benefits. Were you trying to reach 90 degree benefits or does the member also have a policy with us?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh, actually, they gave us the, it, it doesn't have an ID card. Uh, they just gave me, actually I called another person and they gave me this number. They, they look at him and they said that, uh, APL, uh.
[CUSTOMER][NEUTRAL] Uh, benefits took care of that and then she gave me your number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. OK. So I can't look the member's information up with that number. What is the patient's last name?
[CUSTOMER][NEUTRAL] Can I give you the question?
[CUSTOMER][NEUTRAL] Uh, last name, let me spell that one for you. It is [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] That's the first name and last name is [PII]
[CUSTOMER][NEUTRAL] And uh date of birth is [PII] sorry, you don't need that?
[AGENT][NEUTRAL] OK, thank you. OK, now, alright, give me just a moment because I can't search by, yes, I can't search by date of birth, so give me just a moment to try and search by the name.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK, sure.
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so I believe I've located a policy for this member. So if you could, um, first off, [PII], yes, so first off, any information that is provided would be a verification of benefits and not a guarantee of payment. What is the patient's date of birth?
[CUSTOMER][POSITIVE] Oh, perfect.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] And [PII], if you have that ID number you could give it to me so I could update the account.
[AGENT][NEUTRAL] I will. Yes, sir. I will give you that. One moment.
[CUSTOMER][POSITIVE] Great thank you.
[AGENT][NEUTRAL] OK, so I have located this policy and the policy number is 258.
[AGENT][NEUTRAL] 642 5.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the effective date is [PII].
[CUSTOMER][NEUTRAL] Hello, it is.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And there is no prior authorization required with APL.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] On the, on with the bill. OK, perfect. But even though it's an inpatient, it does require or not required on this plan.
[AGENT][NEUTRAL] Uh, there is no prior authorization required on this plan.
[CUSTOMER][POSITIVE] OK, perfect. And, and then, uh, one more thing, [PII].
[AGENT][NEUTRAL] Yes sir and then if you all end up filing.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Oh yeah, sure. Oh, go ahead, go ahead, sorry.
[AGENT][NEUTRAL] I was going to say if you all file a claim for this member's policy once it has been processed [PII] we do have a portal in which you should be able to check claim status and the website for that portal is located at [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] that, uh, after that, sorry?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] A
[AGENT][NEUTRAL] M
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Of [PII]. That's it. Thank you.
[AGENT][NEUTRAL] Yes, sir. And what else? You said you had another question, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes, uh, one more thing, uh, call reference number.
[AGENT][NEUTRAL] Uh yes sir, it would be my name along with today's date.
[CUSTOMER][POSITIVE] Perfect. Thank you so much, [PII]. Uh, have a nice day and please enjoy your weekend. Please stay safe.
[AGENT][NEUTRAL] Yeah. Well, you're certainly.
[AGENT][POSITIVE] Oh well thank you so much. I hope you have a nice uh weekend and rest of your week as well and if that is all I can help you with, and thank you again for calling APL.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][POSITIVE] OK, thank you, [PII] bye bye.
[AGENT][POSITIVE] OK, thank you. Bye bye.
[CUSTOMER][NEUTRAL] Mm.