AccountId: 011433970860
ContactId: 6ad8c614-f7c9-4436-b8db-6f371bb32aa3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 215039 ms
Total Talk Time (AGENT): 101592 ms
Total Talk Time (CUSTOMER): 67956 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/6ad8c614-f7c9-4436-b8db-6f371bb32aa3_20250521T15:52_UTC.wav
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[AGENT][POSITIVE] Good morning thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Good morning [PII]. My name is [PII]. I'm calling from Oklahoma Cancer specialists.
[CUSTOMER][NEUTRAL] So I wanted to see if you can um give me information on a patient's coverage and then um if I need a prior authorization for her treatment for chemotherapy.
[AGENT][POSITIVE] OK. And I'll be more than happy to help you with the policy coverage and the prior off. And [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] [PII]. Let me get you that policy number.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's 024-722229.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment.
[AGENT][NEUTRAL] So I am showing the policy is active. It's been effective since [PII].
[AGENT][NEUTRAL] Um, so hold on one moment, I'm waiting for the benefits to populate.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So this is a secondary um policy, so we pay towards the copay, deductible and co-insurance of coverage charges after their primary insurance, which for
[AGENT][NEUTRAL] This policy, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Were shown as community care for primary?
[CUSTOMER][NEUTRAL] Yes, so I received the prior authorization for the community care for the care, so I just wanted to make sure I don't need one from you guys as well.
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] OK, so for authorization, um, no authorization is required for APL. Um, I was gonna ask you about the benefits. You said you want to go over coverage. Are you all considered outpatient or?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] A a cancer outpatient treatment center?
[CUSTOMER][NEUTRAL] Outpatient.
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK, good. Hold on one second because they have separate coverage for that.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] So the policy will pay up to $4500 per calendar year.
[AGENT][NEUTRAL] There is a $500 deductible per person per calendar year for this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Do you know if she's met any of it?
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, she has met the deductible.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there an out of pocket?
[AGENT][NEUTRAL] Of the max, um, did you need to know how much is remaining from the max?
[CUSTOMER][NEUTRAL] What's her individual out of pocket, do you know?
[AGENT][NEUTRAL] We're secondary, so there is no out of pocket.
[CUSTOMER][NEUTRAL] OK, so no out of pocket.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then does she have a copayment that she has to pay?
[AGENT][NEUTRAL] We pay towards the copay, we don't apply it.
[CUSTOMER][POSITIVE] OK perfect all right thank you so much.
[AGENT][POSITIVE] You're welcome. Was there anything else I could assist you with today?
[CUSTOMER][POSITIVE] That's it I hope you have a great day.
[AGENT][POSITIVE] You also, thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Uh huh bye bye.