AccountId: 011433970860
ContactId: 5d28ca40-6aa4-437e-8058-305d6e918496
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 251130 ms
Total Talk Time (AGENT): 107087 ms
Total Talk Time (CUSTOMER): 98029 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/5d28ca40-6aa4-437e-8058-305d6e918496_20250521T18:09_UTC.wav
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[AGENT][POSITIVE] Thank you for calling.
[AGENT][NEUTRAL] This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, um, my name is [PII] and I was calling to get um eligibility status on a patient.
[AGENT][NEUTRAL] May I please have a callback number?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] And may I have the policy number?
[CUSTOMER][NEUTRAL] Yeah, give me one second.
[CUSTOMER][NEUTRAL] That would be 02134927.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] So the patient is [PII], that's the daughter to the subscriber of [PII].
[AGENT][NEUTRAL] May I have the patient's date of birth?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] And thank you so much [PII] for verifying the policy. You're calling in for eligibility. It does show that the policy is currently active with the effective date of [PII]. Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Um, so I do need to do a prior authorization for her then since it is active. Would you be able to help with that?
[AGENT][NEUTRAL] We don't require prof. We're the secondary, so you would check with the primary insurance.
[CUSTOMER][NEUTRAL] OK. And um what about things being, you know, um, covered, stuff like that. That wouldn't be something I would need to ask you either.
[AGENT][POSITIVE] If you're needing benefits, yes, I can assist you with the benefits.
[CUSTOMER][NEUTRAL] OK. Well, I was just saying like if the procedure that she's gonna have it would be a covered benefit for you guys.
[AGENT][NEUTRAL] Is that for inpatient, outpatient or an office setting?
[CUSTOMER][NEUTRAL] It's an outpatient.
[AGENT][POSITIVE] I'm pulling those benefits up for you now.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And for outpatient benefit, verification of coverage does not guarantee the payment of the claim.
[AGENT][NEUTRAL] The member does have up to $3400 per calendar year that will go towards the primary insurance deductible, co-insurance, or co-pay. This policy is for sickness and injury only. It does not cover any type of preventative or wellness. Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Um, I guess not. You said [PII] or how do you spell your name?
[AGENT][NEUTRAL] It is spelled [PII] the [PII] and today's state as the call reference. If you had any other questions, I don't mind assisting if there is something else that you had a question on?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Well, I was, we usually have to check primary and secondary for our, you know, our authorizations, and you said that we wouldn't need to do it so I just hadn't heard that before, so I really kind of lost.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Well, with this policy, it's like a gap or supplemental, so we don't require prior authorization.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] I don't know.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] We're just based off of the primary insurance.
[CUSTOMER][NEUTRAL] OK, and
[CUSTOMER][NEUTRAL] Right, but then you said also that she um the, the coverage that she has the kind of plan it is, you said it's not for anything preventative or not, what about her surgery though like would she have surgery benefits or?
[CUSTOMER][NEUTRAL] This is an outpatient surgery.
[AGENT][NEUTRAL] If it's due to, if it's due to sickness or injury, then it's considered covered under the outpatient. I just have to advise that we don't do anything for preventative or wellness.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. All right, no problem. All right. Well, that is all I needed. Thank you so much.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK. You're welcome. Well, thank you so much for calling American Public Life, [PII]. You have a great rest of your day.
[CUSTOMER][POSITIVE] You too. Thank you.
[AGENT][POSITIVE] Thank you, bye.
[CUSTOMER][NEUTRAL] Bye-bye.