AccountId: 011433970860
ContactId: 7cefb7cb-e547-42f8-b906-6a89082ef6fa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 308880 ms
Total Talk Time (AGENT): 145245 ms
Total Talk Time (CUSTOMER): 83950 ms
Interruptions: 1
Overall Sentiment: AGENT=1.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/7cefb7cb-e547-42f8-b906-6a89082ef6fa_20250423T12:52_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] Hi [PII], my name's [PII]. I'm calling to check on members' benefits for outpatient surgery.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the benefits, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure it's [PII].
[AGENT][NEUTRAL] And I'm sorry, can you repeat that number? I was typing and it wasn't typing. I'm sorry.
[CUSTOMER][NEUTRAL] No, it's OK, it's [PII].
[AGENT][NEUTRAL] Thank you. May I have the member's policy number?
[CUSTOMER][NEUTRAL] Sure it's going to be uh let me see.
[CUSTOMER][NEUTRAL] Um, 215-217-16 ML 8.
[AGENT][NEUTRAL] And you said 215-217-16?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, um, that's not pulling up a policy. It's something, and it had an email at the end, so something's not.
[CUSTOMER][NEUTRAL] So it says like coverage individual group number effective date plan med link select group then it has an inpatient benefit cert number and outpatient benefit cert number. I give you the outpatient benefit cert number, then there's no other numbers.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But it's too
[AGENT][NEUTRAL] 215-217-16.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And then ML 8 but I'm not sure what that means.
[AGENT][NEUTRAL] What's the um what's the member's group number on there?
[CUSTOMER][NEUTRAL] Group number is 25305.
[AGENT][NEUTRAL] Let me write that down. You said 253-05?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, hold on one second. I don't know why this isn't coming up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what's the member's first and last name?
[CUSTOMER][NEUTRAL] It's going to be [PII]
[AGENT][NEUTRAL] What's her date of birth?
[CUSTOMER][NEUTRAL] Uh, date of birth is going to be [PII].
[AGENT][NEUTRAL] OK, so thank you for verifying. All the information provided is a verification of benefits, not a guarantee of payment. So we have her listed as [PII], but I do have the correct.
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] Oh, I see what it is. That 2 in the front is take that 2 out. So it's 1521716 is the policy number on the system.
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][POSITIVE] And then that should, um, you shouldn't have any problems next time you call.
[AGENT][NEUTRAL] Um, and you said that you needed the outpatient surgery benefits, right?
[CUSTOMER][POSITIVE] Oh perfect.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, hold on one second, let me pull that up for you. So the policy is active, it's been effective since [PII].
[AGENT][NEUTRAL] And for outpatients, um, the policy will pay up to $1000 per calendar day. That does include um surgery in an outpatient facility or a free-standing outpatient surgery center.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Up to $1000 a day and then is that for the provider and the facility or just the facility?
[AGENT][NEUTRAL] That's for any, well, hold on.
[AGENT][NEUTRAL] Provider in the facility, neither it's for the treatment. Um, hold on one second, let me pull up the big one because they don't have the
[CUSTOMER][POSITIVE] Hey, good morning, I enjoy, uh.
[AGENT][NEUTRAL] But it's a surgery.
[AGENT][NEUTRAL] That's for the facility.
[AGENT][NEUTRAL] I had to read the fine print.
[CUSTOMER][NEUTRAL] OK, facility only?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, perfect. Well thank you and then how does it work for submission that just the, the hospital will submit directly to you guys for reimbursement or the patient resubmits?
[AGENT][NEUTRAL] No, um, hospital, let me see who we're second to. So we're second to Cigna. So once Cigna answers and gives the explanation of benefits, then we'll auto, um, the provider should automatically bill us with that explanation of benefits and then your billing and claim form.
[CUSTOMER][POSITIVE] OK perfect well thank you so much.
[AGENT][POSITIVE] You're very welcome, [PII]. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, that would be it.
[AGENT][POSITIVE] Alright, and just for the call, all the information provided was a verification of benefits, not a guarantee of payment, and thank you so much for calling APL [PII]. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.