AccountId: 011433970860
ContactId: 6eed9eda-ded6-4a38-b89e-6c9391dc8ccb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 286040 ms
Total Talk Time (AGENT): 152914 ms
Total Talk Time (CUSTOMER): 81396 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/02/6eed9eda-ded6-4a38-b89e-6c9391dc8ccb_20250402T19:29_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Afternoon, thank you for calling APL. This is [PII]. How can
[CUSTOMER][NEUTRAL] Yeah, so we have a patient here. I need to see if we need a prior. Hi, yes, I have a patient here, um, so we need to see if he needs to get a prior authorization for an outpatient surgery.
[AGENT][NEUTRAL] Can I help you?
[AGENT][NEUTRAL] OK, you're wanting to check to see if prior authorization is required for outpatient surgery, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that and who am I speaking with please?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] Thank you. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number, please, [PII].
[CUSTOMER][NEUTRAL] 02511206.
[AGENT][NEUTRAL] OK, thank you one moment while I get the member's information pulled up.
[AGENT][NEUTRAL] OK, and [PII], any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name please and their date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, [PII] Arrest, [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] [PII] thank you.
[AGENT][NEUTRAL] OK, so I do show that he is the subscriber on the supplemental policy, and the supplemental policy Erica is active effective 7.
[CUSTOMER][NEUTRAL] Uh oh, are you there?
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] Because it is a uh-huh, can you hear me?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Yeah, you just kinda keep cutting out on me, mhm.
[AGENT][POSITIVE] Are you able to hear me, [PII]? Yes, ma'am, and I'm sorry about that. It must, there's a lot of severe wind today where I'm located. I didn't have this problem earlier today, so I'm, I'm thinking that it has something to do with that now, so I do apologize about.
[CUSTOMER][NEUTRAL] Yeah I can hear you now.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So he is on the supplemental policy, and this supplemental policy is active, effective 7-1-2024.
[AGENT][NEUTRAL] And there is no prior authorization required for this supplemental coverage.
[AGENT][NEUTRAL] Now when the claim is submitted to APL day for review we will have to have a copy of his prime.
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][NEUTRAL] Mary Insurance Company's explanation of benefits.
[AGENT][NEUTRAL] And then once our claim has been processed here at APL we do have a portal in which you should be able to check our claim status and the website for that is secured.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, so what needs to be sent there?
[AGENT][NEUTRAL] We in addition to the claim, we will also have to have a copy of his primary.
[AGENT][NEUTRAL] The insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] OK, copy of primary.
[CUSTOMER][NEUTRAL] Insurances explanation of benefits.
[AGENT][NEUTRAL] EOB with uh-huh.
[AGENT][POSITIVE] That is correct, yes ma'am.
[CUSTOMER][NEUTRAL] OK, and I can upload it to that website?
[AGENT][NEUTRAL] The website is where you would go to check our claim status. So once you all have submitted your claim to APL and we've processed that, you should be able to check the status.
[CUSTOMER][NEUTRAL] OK, but there's not any, but there's not a call, but there's no prior needed correct.
[AGENT][NEUTRAL] That is not for APL since this is his supplement. It would follow his primary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, alright, OK, thank you. Can I get a call reference number?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] All right. You're welcome.
[CUSTOMER][NEUTRAL] Do you have a call reference number?
[AGENT][NEUTRAL] Um, sure, you're gonna use my name along with today's.
[AGENT][NEUTRAL] My name and today's date.
[CUSTOMER][NEUTRAL] And what was your name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] What was your [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then what else today's date?
[AGENT][NEUTRAL] OK, and today.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, all right, thank you so much.
[AGENT][POSITIVE] OK. Well, you are very welcome. And is there anything else, [PII], I can help you with?
[CUSTOMER][POSITIVE] No, I think that's it thank you.
[AGENT][POSITIVE] OK. Well, thank you for calling APL and I hope you have a great evening.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you. Bye