AccountId: 011433970860
ContactId: 671910b6-1811-432c-8347-d34b0afdb2f6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 227880 ms
Total Talk Time (AGENT): 93694 ms
Total Talk Time (CUSTOMER): 63410 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/671910b6-1811-432c-8347-d34b0afdb2f6_20250306T15:08_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] calling to see if the patient needs authorization for a procedure being done in the office and how it's covered.
[AGENT][NEUTRAL] OK, let's take a look. Absolutely, [PII]. What's the policy number?
[CUSTOMER][NEUTRAL] Uh, D for Delta 46401632.
[AGENT][NEUTRAL] Unfortunately I can't pull them with that number. Do you have their name or social? I can try and look up, look them up that way.
[CUSTOMER][NEUTRAL] Yeah, I could give you the name. Last name is A.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] First name is [PII].
[AGENT][POSITIVE] Thank you for that. Give me just one moment.
[AGENT][POSITIVE] The unique name so hopefully it'll come right up here.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] And then if I can get patient's date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right, so they do have an active plan with us. Effective date if you need that is [PII]. No pre-authorization is needed for this medical plan. Um, it's a limited benefit plan, so it pays a set amount just depending upon what the patients being seen for.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, do you want the code?
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] We don't have a way on our end to search codes. What are they? Are they coming in? Can you kind of give me an idea of what they're coming in for?
[CUSTOMER][NEUTRAL] It's eye surgery, medically necessary non-cosmetic.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so there's surgery benefit in a hospital outpatient facility or freestanding outpatient surgery center or in a physician's office. Looks like the Benefit max.
[AGENT][NEUTRAL] Is $500 per day and it's a maximum of 1 day per calendar year.
[CUSTOMER][NEUTRAL] So it's a max per day 500 and then I'm assuming anything over that would be the patient's responsibility.
[AGENT][NEUTRAL] Mhm. And if it's in a physician's office, the amount it pays is 125. It is different. The 500 is for hospital, outpatient facility, or surgery center.
[CUSTOMER][NEUTRAL] Alright, so it's 125 they'll pay for the visit and then anything else patient responsibility, OK.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Is there a reference number for the call?
[AGENT][NEUTRAL] Absolutely, that's my name and my uh last initial in today's date. My name again is [PII], which is [PII] Last initial is [PII].
[CUSTOMER][POSITIVE] OK, thanks for your help.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][NEUTRAL] You too bye.