AccountId: 011433970860
ContactId: 99f8a0be-b742-41d2-8f90-faaf878ac5f9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 198830 ms
Total Talk Time (AGENT): 117831 ms
Total Talk Time (CUSTOMER): 52602 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/17/99f8a0be-b742-41d2-8f90-faaf878ac5f9_20250417T19:05_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from Twin Cities Orthopedics. I'm just trying to verify about uh eligibility for a patient and check if a procedure is a covered procedure if I need to get any authorization, things like that.
[AGENT][NEUTRAL] OK, sure, I can assist you with eligibility and benefit information on the policy, Miss [PII], and may I have the um callback number just in case we get disconnected?
[CUSTOMER][POSITIVE] Yeah, it's [PII] and that's correct.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, that is 02611130.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] All right, I.
[AGENT][NEUTRAL] OK, before I give you any benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage, and that's just a disclaimer. We have an effective date of [PII]. It is active at the moment and this is one of our limited hospital indemnity plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and what does that mean for me?
[AGENT][NEUTRAL] Um, with
[AGENT][NEUTRAL] OK, with this one we pay a flat amount, um, anything over as members responsibility. Um, so the flat amount that we cover for a specialist office is gonna be $50 per visit, maximum of 4 visits per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK, we have her scheduled for surgery.
[AGENT][NEUTRAL] OK. Is the surgery gonna take place in office or it's gonna be in an outpatient facility or hospital?
[CUSTOMER][NEUTRAL] It will be.
[CUSTOMER][NEUTRAL] At an outpatient hospital.
[AGENT][NEUTRAL] OK. All right. Let me give you this benefit for the um surgery.
[AGENT][NEUTRAL] And um if it's a hospital or outpatient freestanding surgical center, uh, we cover 250.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, uh, and, um, so authorization is not required because um we're not, yeah, we're not a major medical.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You'll just pay 250 and move on your way.
[AGENT][NEUTRAL] Yeah, that's it.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Perfect and I'm sorry I didn't catch your name at the beginning.
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][POSITIVE] Perfect and do you give call reference numbers?
[AGENT][NEUTRAL] We don't. You can use my name in today's date. Is there anything else I may help you with today, Miss?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I will do that
[CUSTOMER][NEUTRAL] No, that's all I needed.
[AGENT][POSITIVE] OK, well, thank you for calling APR. Have a good afternoon.
[CUSTOMER][POSITIVE] Thanks you too bye bye.
[AGENT][POSITIVE] Thank you, bye bye.