AccountId: 011433970860
ContactId: 97be19a0-4cb0-4a85-a90b-4266a82d4cad
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 182220 ms
Total Talk Time (AGENT): 122441 ms
Total Talk Time (CUSTOMER): 33183 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/97be19a0-4cb0-4a85-a90b-4266a82d4cad_20250219T19:17_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thanks for contacting APO. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, I'm trying to get a prior authorization for our patient, um for, for colonoscopy. [PII] is his name. His date of birth is [PII].
[AGENT][POSITIVE] Thank you. And I'm sorry, I didn't catch your name.
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] Yes, thank you. What's his policy number, please?
[CUSTOMER][NEUTRAL] 02513034
[AGENT][POSITIVE] Thank you. I appreciate that. I just need a callback number, please, while I'm looking that up.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. This policy went into effect on [PII]. It is active.
[AGENT][NEUTRAL] Let me see what we have here. Um, we don't really require a, a prior authorization for these policies. This is a limited benefit hospital indemnity policy. Um, it, it pays, uh, it's, um, it's a discounted plan and what it does is it pays a, a limited benefit for certain services. So, let me see if a colonoscopy is, is, uh.
[AGENT][NEUTRAL] Scheduled or not or whether he can have that done or not. OK, so let's see.
[AGENT][NEUTRAL] That would be inpatient, is it an outpatient hospital? Is that what's um he's having done? It's an outpatient hospital service? OK.
[CUSTOMER][NEUTRAL] Yes, uh-huh.
[AGENT][NEUTRAL] OK. Let me just check here.
[AGENT][NEUTRAL] OK, so for outpatient services, um,
[AGENT][NEUTRAL] We will, uh, pay a flat rate benefit of $250 that's one, per calendar year. That's just a that's just a verification of those benefits, not a guarantee of payment. As I mentioned before, this is not a um.
[AGENT][NEUTRAL] It's not a major medical. It is just a limited benefit policy. Uh, if he needs anesthesia, um, we will, uh, pay the, um, the, the surgical benefit is up to $1000 and, and the surgical or excuse me, the anesthesia benefit is 25% of that. Um.
[AGENT][NEUTRAL] Uh, so that is, uh,
[CUSTOMER][NEUTRAL] So $250.
[AGENT][POSITIVE] Yes, that's correct, yes.
[AGENT][NEUTRAL] Again, just the verification not again to your payment, um, but that is what it will do for for the services that you're we're talking about.
[CUSTOMER][NEUTRAL] OK, and so no um.
[CUSTOMER][NEUTRAL] No prior authorization is required.
[AGENT][NEUTRAL] No, no, because it's not major medical, we do not require prior authorization. Um, you would just send in your claim and, and uh we will be fine.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What was your name?
[AGENT][NEUTRAL] My name is [PII]. The first letter of my last name is [PII]. We're gonna use that today's date as a reference. Is there anything else at all that I can help with, [PII], besides this?
[CUSTOMER][NEUTRAL] No, that's all.
[AGENT][POSITIVE] OK, well thank you for contacting APL have a very good day.