AccountId: 011433970860
ContactId: 7a6e9674-b43d-4b01-8e29-8903d5819f9b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 268529 ms
Total Talk Time (AGENT): 153013 ms
Total Talk Time (CUSTOMER): 44898 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/7a6e9674-b43d-4b01-8e29-8903d5819f9b_20250313T19:21_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] My name's [PII] from Regional Medical Center, and I'm needing to verify um benefits and see if authorizations needed for a patient.
[AGENT][NEUTRAL] Sure, I can check those benefits and see if authorization is required. Uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] D as in dog 43,731,210.
[AGENT][NEUTRAL] OK, so that's actually not one of our policy numbers, [PII] that is through, uh, they're called 90 Degrees. Um, if you have their social I can search for them that way to see if they have a policy with us.
[CUSTOMER][NEUTRAL] Yeah, because I got this number on the back of the card, um, their social is [PII].
[AGENT][MIXED] It is confusing. I think that same phone number can actually get you to them as well um the prompts at the beginning are a little misleading, um, but they very well might still have a policy with us. We can check.
[CUSTOMER][NEUTRAL] The social is [PII].
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what was the patient's name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Do you have the date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Perfect. OK, thank you for verifying that. So, uh, they do have a policy with us. It is currently active. Uh, that effective date was [PII], and whenever you're ready I can give you that policy number that they have with us.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, it is 02.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] 5047.
[AGENT][NEUTRAL] 00.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and so this is a limited indemnity medical plan, so essentially just pays a set dollar amount per covered procedure or office visit. Uh, there is no authorization required for anything under this policy.
[CUSTOMER][NEUTRAL] OK, so she is, uh, came through ER and is now in an observation status. Is there any coverage for that?
[AGENT][NEUTRAL] Let me check those emergency room benefits. Give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK, I appreciate your patience, um, and so of course uh.
[AGENT][NEUTRAL] Verification of coverage is not a guarantee of payment for claims, um, so there's not any particular emergency room benefits as this is a limited indemnity plan. It is very particular, um, so she does have, um, hospital admission excuse me, hospital admission benefits, um, if she were to be confined, there's a hospital confinement benefit.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] There's also a surgical benefit and then diagnostic testing benefits, and that's all that she has for this policy and that being said, she could have other coverages through 90 Degrees. That first policy number that you gave me, she might have something else through them, but this is what she has with us.
[CUSTOMER][NEUTRAL] What do I
[CUSTOMER][NEUTRAL] How do I contact them?
[AGENT][NEUTRAL] Um, I can give you that phone number. We'll see if that's the same one you called. If it is, um, it's option 3 that you select to get to them. Give me just a moment, let me get that.
[AGENT][NEUTRAL] OK, uh, so their phone number is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And again if you call that that's so yes option one would take you to them.
[CUSTOMER][NEUTRAL] Yeah, that's the number I just
[CUSTOMER][NEUTRAL] Oh I thought you just said option 3.
[AGENT][NEUTRAL] Oh, I'm sorry, yeah, option one, I apologize.
[CUSTOMER][POSITIVE] Alright, thank you.
[AGENT][NEUTRAL] Alright, yes, was there anything else I can help you with?
[CUSTOMER][NEUTRAL] That's it.
[AGENT][POSITIVE] Alright well thanks for giving us a call have a great rest of your day.