AccountId: 011433970860
ContactId: b1129669-09be-4e06-830e-21ab926890e7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 230320 ms
Total Talk Time (AGENT): 116236 ms
Total Talk Time (CUSTOMER): 67204 ms
Interruptions: 2
Overall Sentiment: AGENT=0.5, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/b1129669-09be-4e06-830e-21ab926890e7_20250114T19:29_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh hi, I'm calling to verify eligibility and um benefits and pre-cert for outpatient surgery.
[AGENT][NEUTRAL] OK, I can help you with eligibility and benefits. Uh, can I please get your name and your callback number?
[CUSTOMER][NEUTRAL] Sure, it's [PII] last initial R [PII].
[AGENT][NEUTRAL] OK, thank you, Ms. [PII]. And what is the patient's name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and then what is [PII]'s date of birth?
[CUSTOMER][NEUTRAL] Uh [PII].
[AGENT][NEUTRAL] And her policy number please?
[CUSTOMER][NEUTRAL] 019078883.
[AGENT][NEUTRAL] OK, let me pull that up.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I do show that [PII] does have an active policy and her effective date is
[AGENT][NEUTRAL] [PII] and this is just to verify coverage it's not a guarantee of payment. This is a policy that helps with uh deductible copay or co-insurance. It's a secondary gap policy. She has an inpatient benefit amount of $6800 per calendar year.
[AGENT][NEUTRAL] And then she also has an outpatient benefit amount of $6800 per calendar year that goes towards deductible copay or co-insurance.
[CUSTOMER][NEUTRAL] OK, and you coordinate with the primary, is that how that works?
[AGENT][NEUTRAL] Right, right, the primary is bill first and then we're billed 2, with the EOB and the itemized statement.
[CUSTOMER][NEUTRAL] R.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] OK. Um, is there any deductible on your part or anything like that?
[AGENT][NEUTRAL] I do not see that she has an ER deductible or any deductible. It does the policy does help with the deductible co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK. OK. And is there any kind of prior.
[AGENT][NEUTRAL] And there's not a network.
[AGENT][NEUTRAL] Because
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am. Go ahead.
[CUSTOMER][NEUTRAL] Go ahead sorry no no no no you go ahead you were talking.
[AGENT][NEUTRAL] OK, there's not a network because it's not her major medical insurance. And um looking at what you asked about prior, so let me see if anything's been used this year for you.
[CUSTOMER][NEUTRAL] That.
[AGENT][NEUTRAL] I'm not showing that anything has been used this year so far.
[CUSTOMER][NEUTRAL] OK, and is any kind of prior authorization required on your end?
[AGENT][NEUTRAL] No ma'am, there's no authorization required.
[CUSTOMER][NEUTRAL] OK, and did you say your name was [PII]?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, and do you have a call reference number or just your name?
[AGENT][NEUTRAL] You can just use my name and today's state.
[CUSTOMER][NEUTRAL] OK, is it [PII], is that correct?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 2, OK.
[CUSTOMER][POSITIVE] All right, that's all I need. Thank you so much.
[AGENT][POSITIVE] Oh, you're welcome, Miss [PII]. You have a great day and thanks for calling APL.
[CUSTOMER][POSITIVE] Thank you