AccountId: 011433970860
ContactId: 757f5b4d-eb7b-4870-a424-8ab67e90bdea
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 369799 ms
Total Talk Time (AGENT): 153006 ms
Total Talk Time (CUSTOMER): 98304 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/757f5b4d-eb7b-4870-a424-8ab67e90bdea_20250509T20:22_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from Western Surgical Group. I'm just trying to get some benefits and eligibility for a patient and um.
[CUSTOMER][NEUTRAL] Uh, surgery cost?
[AGENT][NEUTRAL] Surgery cost or how much we pay to a surgery?
[CUSTOMER][POSITIVE] He like the allowable, allowable amounts for a surgery for his procedure code.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, well, I can definitely help you with the eligibility and the benefits. And [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the policy number I have is 025.
[CUSTOMER][NEUTRAL] 85017.
[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], [PII].
[AGENT][POSITIVE] Thank you for that and all the information provided is a verification of benefits.
[AGENT][NEUTRAL] Not a guarantee of payment, and I am showing that the policy is active, it's been effective since [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And for the, the surgery, would it be outpatient or is it going to be an inpatient surgery?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, outpatient.
[AGENT][NEUTRAL] Outpatient, OK, hold on one moment.
[AGENT][NEUTRAL] OK, so for surgery in a hospital, hospital outpatient facility or freestanding outpatient surgery center, the policy will pay up to $2000 per day with a max of 1 day per calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm sorry, the phone went in and out. I didn't hear you.
[CUSTOMER][NEUTRAL] Oh no no no I was just acknowledging what you said.
[AGENT][NEUTRAL] OK, sorry.
[CUSTOMER][NEUTRAL] Mm, no, you're fine.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Um, there's no.
[CUSTOMER][NEUTRAL] Specific percentage that you guys allow like Medicare rate or?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Anything like that?
[AGENT][NEUTRAL] So this is a hospital indemnity policy. So it's a limited medical policy. So it's like a list of coverages and then the dollar amount that would be applied to that and anything outside of it, it wouldn't be covered by this policy.
[CUSTOMER][NEUTRAL] One second, my dear, what was your name?
[AGENT][NEUTRAL] Mhm. My name is [PII].
[CUSTOMER][NEUTRAL] And then I'm sorry, can you just repeat what you said I'm just typing it out.
[AGENT][NEUTRAL] Oh, sure. Um, oh Lord, I have to remember, what was the question? I'm sorry.
[CUSTOMER][POSITIVE] I'm sorry
[CUSTOMER][NEUTRAL] Like it was just like um I was told that usually certain plans, you know, they have an allowable percentage based off of Medicare rates that you guys cover.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Right, so this is a hospital indemnity policy?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Which is a limited medical benefit policy.
[AGENT][NEUTRAL] So there's just a
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] So there's a list of covered services and the dollar amount that would be applied?
[AGENT][NEGATIVE] Anything not listed, uh, wouldn't be covered by the policy.
[CUSTOMER][NEUTRAL] And do you mean by like, like procedure codes?
[CUSTOMER][NEUTRAL] Or
[AGENT][NEUTRAL] What do you mean in reference to which, what part?
[CUSTOMER][NEUTRAL] Like you said there's a list of things with the dollar amount that is covered by the policy, but if it's not listed, then it's not covered.
[AGENT][NEUTRAL] Right, so like it's.
[CUSTOMER][NEUTRAL] So my question is if I
[AGENT][NEGATIVE] It's broken down
[CUSTOMER][NEUTRAL] If I give you a procedure.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, no, we don't use the procedure codes. It's broken down by benefit name. So like outpatient um accident and sickness surgery benefit has this uh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Under that is the surgery benefit and the dollar amount that I read off to you. There's also preventative elective surgery benefit. So if it's a preventative, um, or elective surgery, they also have surgery in an outpatient facility which is the same $2000 per day with a max of 1 per calendar year. So it's just the
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] A list of
[AGENT][NEUTRAL] Names, not codes of covered, um, services and the benefit amount that would be paid towards it.
[CUSTOMER][NEUTRAL] And then I know you guys don't give out reference numbers, so I just use your name and today's date, right?
[AGENT][NEUTRAL] Yes, that's correct. And the first initials of my last name is [PII].
[CUSTOMER][POSITIVE] OK, great. Thank you so much and I hope you have a great day.
[AGENT][POSITIVE] You're awesome and thank you for calling APL. I hope you have a great day as well. Thank you, [PII].
[CUSTOMER][NEUTRAL] Mhm bye bye.
[AGENT][NEUTRAL] Bye bye.