AccountId: 011433970860
ContactId: 55f0175a-9cba-43cd-b47c-7b7bf7df3f6e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 166979 ms
Total Talk Time (AGENT): 80989 ms
Total Talk Time (CUSTOMER): 66059 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/14/55f0175a-9cba-43cd-b47c-7b7bf7df3f6e_20250214T19:28_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling to get outpatient surgery benefits on a member, please.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the outpatient surgery, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] My direct line is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] 02566894
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. I am showing the policy is active, it's been effective since [PII]. And you said outpatient surgery?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, so the outpatient benefit for um accident or and sickness surgery is up to $1500 per calendar year.
[AGENT][NEUTRAL] A max of 2 surgeries per calendar year.
[CUSTOMER][NEGATIVE] He hasn't used any of these benefits.
[AGENT][NEUTRAL] Let me double check for you. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[AGENT][NEGATIVE] Yes, so far none of the benefits have been used.
[CUSTOMER][POSITIVE] Wonderful. Now is there authorization required?
[AGENT][NEUTRAL] No prior authorization is required because we're not the major medical insurance.
[CUSTOMER][NEUTRAL] Got you. Now this is the only insurance we have on file for him, so are you guys, OK, OK.
[AGENT][NEUTRAL] Right. Major just saying APL is not a major insurance company.
[CUSTOMER][POSITIVE] Got you. OK, wonderful. Uh, I think that's all I need, Miss [PII]. Uh, he doesn't have like deductible, co-insurance, anything like that.
[AGENT][NEUTRAL] Correct, um, it's just the benefit amount, um, because it's a hospital indemnity policy, so it's a limited benefit amount or policy.
[CUSTOMER][NEUTRAL] Got you, it's a limited policy alright if there's any way to get a reference number for our call, I will be done.
[AGENT][NEUTRAL] Um, so there's no call reference number, but you can use my name in today's date and again that's [PII], first initial of my last name is [PII], and then today's date.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][POSITIVE] Perfect thank you so much have a good weekend.
[AGENT][POSITIVE] You also, and thanks for calling APL. Bye-bye.
[CUSTOMER][POSITIVE] Thank you bye bye.