AccountId: 011433970860
ContactId: 65e4021f-9514-4cb3-90f2-7d16df19ae01
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 352950 ms
Total Talk Time (AGENT): 153823 ms
Total Talk Time (CUSTOMER): 53533 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/65e4021f-9514-4cb3-90f2-7d16df19ae01_20250303T18:37_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I was calling to check uh eligibility and benefits for patient and also inquire about prior authorization.
[AGENT][NEUTRAL] OK, so you're needing eligibility benefits and see if prior authorization is required, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and [PII], what is a good call back number for you?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] 02507990
[AGENT][NEUTRAL] OK [PII] thank you give me a moment to get the member's information pulled up please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And [PII], any information that I provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So I do show that she is the subscriber on this limited benefit plan and it is active with an effective date of.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Excuse me, [PII]. And what type of benefit information do you need for her inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Outpatient.
[AGENT][NEUTRAL] OK. Let me pull up her benefits. One moment.
[AGENT][NEUTRAL] OK. On the outpatient benefits for this plan, she had, it's a maximum of $75 per visit.
[AGENT][NEUTRAL] With a max number of 5 visits per calendar year per covered person.
[CUSTOMER][NEUTRAL] What about outpatient hospital?
[AGENT][NEGATIVE] Uh, that would fall under this.
[CUSTOMER][NEUTRAL] She have a surgical benefit?
[AGENT][NEUTRAL] Oh, this is, this is for sur I'm sorry, I didn't realize it was for surgery.
[CUSTOMER][NEUTRAL] That would fall under that?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So she has, let me look, let me look at one additional piece of information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so under her.
[AGENT][NEUTRAL] Outpatient surgical benefits, she does have, I'm sorry, I'm having trouble with one of my screens. I'm sorry.
[CUSTOMER][NEUTRAL] You're fine.
[AGENT][NEUTRAL] On this limited benefit plan, the surgical benefit amount is $1000.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the anesthesia, if there's anesthesia, which I'm assuming there would be, then that, the anesthesia benefit amount is 25% of the surgical benefit up to the $1000 would be the max.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] And then once the claim has been submitted and processed through APL we do have a portal Marian in which claim status should be able to be checked and our website for that is secured. [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on this policy, because it's not major medical coverage, there is no prior authorization required.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] And do you have any other questions?
[CUSTOMER][NEUTRAL] Uh, can I get a rep?
[AGENT][NEUTRAL] Is there anything else I can help you with? Sure. For your reference number? Yes, ma'am, you would use my name along with today's date.
[CUSTOMER][NEUTRAL] A reference number, yeah.
[CUSTOMER][NEUTRAL] It was [PII].
[AGENT][NEUTRAL] Yes ma'am, uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 29
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] OK. Well, you are certainly very welcome. So if that's all I can help you with, and thank you again for calling APL and I hope you have a really nice rest of your day.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][POSITIVE] Yes, ma'am. Thank you.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Bye-bye.