AccountId: 011433970860
ContactId: 9334fb5e-c973-4868-a19f-9480b635293c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 137929 ms
Total Talk Time (AGENT): 60939 ms
Total Talk Time (CUSTOMER): 54552 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/9334fb5e-c973-4868-a19f-9480b635293c_20250520T18:22_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hello [PII], I'm calling about, uh, my name is [PII] calling from Prisma Health with the authorization department. I'm calling to see if one of your members needs a prior authorization for a certain CPT code.
[AGENT][POSITIVE] OK, I'd be happy to assist with prior authorization today, [PII], if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] 02137788.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment. Now I do show this is um our gap policy, so no, um, authorization would not be required just I guess only through the major medical but not us.
[CUSTOMER][NEUTRAL] OK, does he have any benefits for us first as a secondary or no?
[AGENT][NEUTRAL] For inpatient or outpatient?
[CUSTOMER][NEUTRAL] His primary is Cigna Great West.
[CUSTOMER][NEUTRAL] Out
[AGENT][NEUTRAL] OK, so for outpatient I do show the per day maximum is $500.
[CUSTOMER][NEUTRAL] OK, so this is like a hospital indemnity plan or something like that.
[AGENT][NEUTRAL] No, it's a gap policy, so the claim would go first to the major medical and then once they have assigned patient responsibility such as deductible or co-pay or co-insurance, then the claim comes for us for processing and we'll pay up to $500 per day for his outpatient.
[CUSTOMER][NEUTRAL] So, so he
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, [PII], can I get a um first initial to your last name and any kind of a call reference number please?
[AGENT][NEUTRAL] Reference is just gonna be my name [PII] last initial [PII], and the date and time of the call. Was there anything else I could assist with today?
[CUSTOMER][POSITIVE] No, that's perfect thank you so much.
[AGENT][POSITIVE] Thank you for calling APL you have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.