AccountId: 011433970860
ContactId: 6f7e67df-2181-44fa-95f9-24ba14920cc2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 220440 ms
Total Talk Time (AGENT): 115639 ms
Total Talk Time (CUSTOMER): 50613 ms
Interruptions: 1
Overall Sentiment: AGENT=2.7, CUSTOMER=2.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/6f7e67df-2181-44fa-95f9-24ba14920cc2_20250331T19:02_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] and I'm calling to verify uh eligibility and see if authorization is needed on a patient.
[AGENT][NEUTRAL] OK, [PII], you're needing eligibility and to find out a prior authorization is required, is that correct?
[CUSTOMER][POSITIVE] Yes, that is right.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Thank you and the member's policy number now please, [PII].
[CUSTOMER][NEUTRAL] It is 02576527.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] And any information, [PII], 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 and their date of birth?
[CUSTOMER][NEUTRAL] This is for [PII], [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so I do show that she is a dependent on this limited benefit plan. Um, the policy is active [PII] with an effective date of [PII].
[AGENT][NEUTRAL] And on this plan there is no prior authorization required.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Does the plan cover outpatient surgery done in an outpatient hospital?
[AGENT][NEUTRAL] Just let me pull the benefits up. Just one moment.
[AGENT][NEUTRAL] OK, so on this limited benefit plan, the, yes, there are benefits for outpatient surgery. The benefit would be, and that you did say this is gonna be done at a facility or an outpatient.
[AGENT][NEUTRAL] Surgery center.
[CUSTOMER][NEUTRAL] Yes, outpatient hospital, and it's not an ASC it's just outpatient.
[AGENT][POSITIVE] Yes, so the benefit.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] This benefit is $1000 per day, maximum of 1 day per calendar year per covered person.
[CUSTOMER][NEUTRAL] OK, so it's just a flat rate.
[AGENT][NEUTRAL] Yes, ma'am. If this is not major medical insurance, correct. This is a limited benefit plan. Mhm.
[CUSTOMER][NEUTRAL] For a procedure.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Alright [PII], may I get a reference number for our call please?
[AGENT][NEUTRAL] Sure, you would use my name along with today's date and then one last thing, Pam, once the claim has been processed, we do have a portal in which you should be able to check claim status, and our portal website is located at [PII].
[CUSTOMER][POSITIVE] OK, thank you so much for that.
[AGENT][POSITIVE] Well, you are certainly very welcome. And is there anything else that I can help you with?
[CUSTOMER][POSITIVE] Not at this time, thank you.
[AGENT][POSITIVE] Well, you're very welcome and thank you again for calling APL. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you, [PII] you too bye bye.
[AGENT][POSITIVE] Yes, ma'am. Thank you. Bye-bye.