AccountId: 011433970860
ContactId: 5dcf13a8-7a44-48ca-af29-ea733327a070
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 340279 ms
Total Talk Time (AGENT): 133279 ms
Total Talk Time (CUSTOMER): 157220 ms
Interruptions: 4
Overall Sentiment: AGENT=0.6, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/5dcf13a8-7a44-48ca-af29-ea733327a070_20250114T21:23_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Oh, I'm sorry, I need to check benefits for a member and see if an authorization is required.
[AGENT][NEUTRAL] OK, I can help you. And what's your name?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And what's the policy number, [PII]?
[CUSTOMER][NEUTRAL] D Delta 45310888
[AGENT][NEUTRAL] Can you spell the patient's first and last name?
[CUSTOMER][NEUTRAL] Uh [PII], excuse me, [PII]
[AGENT][NEUTRAL] OK, thank you and what's your phone number, [PII] in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what phone number did you dial, [PII]?
[CUSTOMER][NEUTRAL] I dialed [PII] and that's just based on a number that was keyed in.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, do you have the ID card?
[CUSTOMER][NEUTRAL] To her account we don't have a card, no.
[AGENT][NEUTRAL] OK, I do not have the card and give me that number again.
[CUSTOMER][NEGATIVE] Do not have the card.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] I'm gonna get you transferred over to 90 Degrees cause, oh, OK, I can't hear them.
[CUSTOMER][POSITIVE] I'm gonna shut my door. My neighbor is talking. OK, 90 degree benefit. My neighbor's talking so loud I can't hear, but thank goodness gracious. It's like we're all trying to do what we need to do. All right, I'm ready.
[AGENT][POSITIVE] OK. I'm gonna get you transferred over there and I'll provide them with this number, OK?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] It
[CUSTOMER][POSITIVE] Oh thank you.
[AGENT][NEUTRAL] You're welcome. Hold on one second.
[CUSTOMER][NEUTRAL] OK, yes.
[CUSTOMER][NEUTRAL] Thank you for calling 90 Degree Benefits, the administrator for benefits in a card members. Please select from the following options to ensure you are directed to the appropriate party to answer your questions. For questions on IMA Mec Wellness, MVP plans, or COBRA enrollment, please press 1.
[CUSTOMER][NEUTRAL] 90 degree Benefits. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hey [PII], this is [PII]. How are you?
[CUSTOMER][POSITIVE] Hi, I'm just lovely. How are you?
[AGENT][NEUTRAL] And you know what, I don't need to talk to you because I just found it.
[CUSTOMER][POSITIVE] Hey, I like that. That's easy.
[AGENT][NEUTRAL] I know it, never mind.
[CUSTOMER][POSITIVE] OK. Have a good one.
[AGENT][NEUTRAL] OK. You too. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] What is [PII]'s date of birth?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, I did not have to transfer you. I've located her policy number. Let me, let me give you the APL policy number.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Oh, got it, OK.
[AGENT][NEUTRAL] It is 256-9870.
[AGENT][NEUTRAL] And the policy effective date is [PII]. Uh, the policy is active and you wanted, you wanted to verify benefits and if pre-certification is required. OK. What's the pre-cert for?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It's for an outpatient surgery, uh, Bacoli.
[AGENT][NEUTRAL] OK, pre-certification is.
[CUSTOMER][NEUTRAL] Procedure is force.
[AGENT][NEUTRAL] Yeah, it's not required.
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEGATIVE] It's not OK, it's not required.
[AGENT][NEUTRAL] It, it's not required. And then for surgery in an outpatient hospital slash or facility.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] Give me one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The benefit is $250 per day.
[AGENT][NEUTRAL] A maximum of one day per calendar year per covered person.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Ah, OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Under this policy?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, it's a limited plan it sounds like OK.
[AGENT][NEUTRAL] It is, it is.
[CUSTOMER][NEUTRAL] OK, so there's no off required, but and she may have exhausted that benefit.
[AGENT][NEUTRAL] No, I don't show. Um, it's, it's, it's one per calendar year. I don't show that she's had any type of outpatient surgeries at this time.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] I don't have any claims, yeah, mhm.
[CUSTOMER][NEUTRAL] OK, OK, no, OK.
[AGENT][NEUTRAL] And of course the information provided is verification, uh, not a guarantee of payment, [PII], and did you have any other questions?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] So the 250 per day, that's just um does that go for the the procedure, the provider, the facility all inclusive, so whoever bills first basically.
[AGENT][NEUTRAL] Mhm. Mm, it is. Pretty much, pretty much.
[CUSTOMER][NEUTRAL] OK, OK, got you alright and um what is your name again?
[AGENT][NEUTRAL] Uh, you'll use my name in today's date as reference for today's call, [PII], first initial last name is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, very good. I appreciate it.
[AGENT][POSITIVE] All [PII]. Anything else I can assist with today?
[CUSTOMER][POSITIVE] No, ma'am, hope you have a good afternoon.
[AGENT][POSITIVE] OK. Uh, you too, and thanks for calling APL. Have a good day.
[CUSTOMER][POSITIVE] You're welcome. Bye-bye.
[AGENT][NEUTRAL] Bye bye.