AccountId: 011433970860
ContactId: 66f1893b-8c15-4dc3-aac3-a48fda6f98ca
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 359859 ms
Total Talk Time (AGENT): 125077 ms
Total Talk Time (CUSTOMER): 121036 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/66f1893b-8c15-4dc3-aac3-a48fda6f98ca_20250124T18:17_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] with Prisma Health in [PII], and um I wanna check eligibility and benefits for this member and then I'll need um if you have an authorization department to find out if I need authorization.
[AGENT][POSITIVE] OK, [PII], I'm happy to check on a policy for you. What's the member's uh policy number?
[CUSTOMER][NEUTRAL] Um, D as in David, 43728858.
[AGENT][NEUTRAL] OK, I unfortunately can't pull the number with that number. Do you have their name or social?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Um, their name is [PII], and let me see if her So, yep, [PII] is [PII].
[AGENT][POSITIVE] Alright, thanks so much [PII]. Let me take a look by that and see what I find here.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And we're looking for, um, I'm sorry, medical or dental?
[CUSTOMER][NEUTRAL] Medical.
[AGENT][NEUTRAL] Medical. OK. One second.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is that ID number do they have new ID numbers?
[AGENT][NEUTRAL] So let me take a look.
[CUSTOMER][NEUTRAL] Because you said you couldn't pull it by that number?
[AGENT][NEUTRAL] Yeah, let me see here. What is um [PII]'s date of birth?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] OK. I think I found it here, one sec.
[AGENT][NEUTRAL] OK, yeah, so let me give you the policy number for the member.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It is 02.
[AGENT][NEUTRAL] 37.
[AGENT][NEUTRAL] 1130.
[CUSTOMER][NEUTRAL] OK, and did they get new cards? Because the card we have on file has that the number I gave you. Do they have, is it different now?
[AGENT][NEUTRAL] It must be a different card then yeah because I pulled their card up and I don't see that on there do you see the group is management analysis and utilization?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] No, I don't see that name on there, um.
[CUSTOMER][NEUTRAL] Oh, MAU Workforce Solutions is on the card.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] Group 9437, so it just must be a new newer card. I don't know.
[AGENT][NEUTRAL] Yeah, it looks like it's a different card, yeah.
[CUSTOMER][NEUTRAL] Ah
[AGENT][NEUTRAL] But the plan is active. The effective date is [PII]. It looks like a 23.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah let me see if
[CUSTOMER][NEUTRAL] And is there um co-insurance, deductible out of pocket?
[AGENT][NEUTRAL] No, it's a limited benefit plan, so we call it a hospital indemnity plan. It just pays a set amount depending upon what the patient's being seen for, uh, so there's no deductible on this.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, and what is this set amount?
[CUSTOMER][NEUTRAL] Oh, you said depends on what they're being seen for OK.
[AGENT][NEUTRAL] Mhm, mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so I need to find out if I need prior authorization for a code. Are you able to do that or is that a different number?
[AGENT][NEUTRAL] We no pre-authorization is required um.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] For the member plans.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] If I tell you the procedure, would you be able to tell me what the amount is paid towards it?
[AGENT][NEUTRAL] Are they having like a procedure in office in hospital?
[CUSTOMER][NEUTRAL] It's an outpatient hospital, it's a CT scan.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] It looks like the maximum benefit is $500.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that would be for any, it looks like outpatient in a hospital outpatient facility, freestanding surgery center or physician's office.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, um, and no places are required for the CT, um, all right, [PII], uh, can I just get the initial to your last name and a call reference?
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Absolutely references my name with my last initial. My last initial to my name is [PII].
[CUSTOMER][POSITIVE] All right. Thank you so much.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.