AccountId: 011433970860
ContactId: a973d9e5-c128-4c7e-a61f-1c6cfb28d16a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 341880 ms
Total Talk Time (AGENT): 121560 ms
Total Talk Time (CUSTOMER): 122680 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/25/a973d9e5-c128-4c7e-a61f-1c6cfb28d16a_20250325T18:30_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Here and it's OK. I'm not expecting.
[CUSTOMER][NEUTRAL] Hi, um, I'm not even sure if I've got the right area but because I'm trying to see what on the card. I couldn't tell where I was gonna be directed to, but I'm trying to see if authorization is required for a outpatient MRI and this is the number that was on the card to call.
[CUSTOMER][NEUTRAL] Uh, I'm calling from provider's office.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, um, I can definitely check the policy and the benefits for you, but in terms of the prior authorization, APL doesn't require one because we're not a major medical.
[CUSTOMER][NEUTRAL] OK, but you are, but it is a medical policy, but it just doesn't require that.
[CUSTOMER][NEUTRAL] That what you're saying it is a, it does have benefits, but it just doesn't require authorization.
[AGENT][NEUTRAL] Our company as a whole doesn't require authorization because we're not a major medical company like Blue Cross or Aetna.
[CUSTOMER][NEUTRAL] Right, right. But I mean, do you have benefits for outpatient hospital?
[AGENT][NEUTRAL] So I can look up the policy and see the benefits.
[AGENT][NEUTRAL] I will have to ask, I can look that up for you. May I have your name?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] And [PII], may I have a good contact number in case we're disconnected and then the policy number?
[CUSTOMER][NEUTRAL] It's [PII] and the policy number is D as in dog, 47694162.
[AGENT][NEUTRAL] Alrighty, do you have a copy of the member's ID card there with you?
[CUSTOMER][NEUTRAL] I do.
[AGENT][NEUTRAL] On the ID card, do you see anywhere that um has in-hospital or outpatient policy cert number?
[CUSTOMER][NEUTRAL] No, that's the problem. I mean, on the card it's just got a medical benefit verification number and that's on the back of the card. On the front of the card, it's just got, uh, let's see, hold on a second.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, I mean, it's just got the member ID number, uh, pharmacy information, multi plan to find a provider, visit this call this number or visit a website.
[CUSTOMER][NEUTRAL] And then something about a vertical care is just a call or click away.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] So there's nothing on here about that's why I was not be able to call. I just called this number.
[AGENT][NEUTRAL] Policy.
[AGENT][NEUTRAL] OK. May I, do you have the member's full social?
[CUSTOMER][NEUTRAL] Yeah, let me look.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Alright, so I'm just waiting for the policies to populate. Hold on one moment.
[CUSTOMER][NEUTRAL] Oh you're fine.
[AGENT][POSITIVE] And it's really taking its time. Let me try another screen.
[AGENT][NEUTRAL] What's the member's first and last name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes, uh-huh.
[AGENT][NEUTRAL] Let me try this way. Hold on one second.
[AGENT][NEUTRAL] OK, let me see. I'm not sure, so with the social, nothing came up. So I'm looking with the first and last name.
[AGENT][NEUTRAL] But I don't see a policy for for [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] On, on the car to the top left corner.
[CUSTOMER][NEUTRAL] And they gave this, they turn to this.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] On the card to the top left corner, does it say APL on it?
[CUSTOMER][NEUTRAL] No, it's got
[CUSTOMER][NEUTRAL] Surge.
[AGENT][NEUTRAL] OK. Mhm.
[CUSTOMER][NEUTRAL] Then gave me a group number, so I don't know.
[AGENT][NEUTRAL] On the, on the back of the card, the phone number, did you call [PII] or [PII]? I think I know what's happening.
[CUSTOMER][NEUTRAL] [PII], let me see what this on here. [PII].
[AGENT][NEUTRAL] [PII]. OK. So that [PII] number is 90 degree benefits. So you call that number, but there's an, I think it's option two, whatever option there is an option that will direct you to APL no matter who you are. So call that number back but put 0 for customer service so you can get to them.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So don't hit APL.
[AGENT][NEUTRAL] No, don't hit APL. They don't have.
[CUSTOMER][NEGATIVE] Don't hit nothing but 0.
[AGENT][NEUTRAL] Yeah, because they don't have APO, they have surge.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so just hit 0.
[AGENT][POSITIVE] Yes, ma'am, and then they'll their customer service will be able to help you.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Thank you, bye bye
[AGENT][NEUTRAL] Bye bye.