AccountId: 011433970860
ContactId: a2a4f6f3-2497-4c42-a44a-1507e34e80e2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 172490 ms
Total Talk Time (AGENT): 77808 ms
Total Talk Time (CUSTOMER): 67066 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/a2a4f6f3-2497-4c42-a44a-1507e34e80e2_20250326T12:52_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, my name is [PII], and I was calling to verify benefits for a patient that's coming in for a procedure and see if authorization is required.
[AGENT][POSITIVE] OK, well, I can definitely help you with the benefits and the authorization, and can you repeat your name for me, please?
[CUSTOMER][NEUTRAL] Yes, my name is [PII] My initials of my last name is [PII] and [PII], what's the initial to your last name?
[AGENT][NEUTRAL] Please
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And Ms. [PII], may I have a good contact number in case we're disconnected and then the policy number?
[CUSTOMER][NEUTRAL] The contact number is [PII].
[CUSTOMER][NEUTRAL] Policy number is, I'm sorry, um.
[CUSTOMER][NEUTRAL] here, um, let me go back to the first policy number member ID number is 2180312.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII], um, date of birth is [PII] I'm sorry, [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So I am showing the policy is active. It's been effective since [PII].
[AGENT][NEUTRAL] And you said um they're having like an outpatient procedure?
[CUSTOMER][NEUTRAL] Yes, they're having, he's having an outpatient um test the CPT code 71271.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I'm showing this is like a secondary plan or something?
[AGENT][NEUTRAL] Right, so for outpatient, the calendar year max is $6000. Um, did you want me to see if, if they've used any of that balance for the year?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And then as far as the authorization, um, APL does not require prior authorization because we're not a major medical insurance company.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And and he has not used any of the benefits for [PII], so he still has that full balance to use towards outpatient expenses.
[CUSTOMER][NEUTRAL] OK, so this pays toward the first insurance, right?
[AGENT][NEUTRAL] We pay towards the copay, deductible and co-insurance of coverage charges after primary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so can I get a reference number for this call, please?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name and today's date.
[CUSTOMER][POSITIVE] OK, thank you so much, [PII].
[AGENT][POSITIVE] You're welcome, Ms. [PII]. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] You're welcome you have a good day.
[AGENT][POSITIVE] Alright, thanks for calling APL. Bye bye.
[CUSTOMER][NEUTRAL] OK.