AccountId: 011433970860
ContactId: b9bbb0ba-01b5-4460-818a-5243dc33177b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 253220 ms
Total Talk Time (AGENT): 98684 ms
Total Talk Time (CUSTOMER): 126541 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/b9bbb0ba-01b5-4460-818a-5243dc33177b_20250512T14:10_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hello, my name is [PII], and I'm calling to uh get approval to have uh some cataract surgery. And um I, I guess, do I give you my, um,
[CUSTOMER][NEUTRAL] Number for my insurance or how, how do I get that?
[AGENT][POSITIVE] OK, I'll be happy to assist today, Ms. [PII]. If I can get a good call back number for you first.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you for that information.
[AGENT][NEUTRAL] OK, and what is the policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, the policy number, uh, that I have is, uh.
[CUSTOMER][NEUTRAL] It's group number 26758. It's Medlink and
[CUSTOMER][NEUTRAL] I guess that is the number on the front of it. OK, I've not used it before so.
[AGENT][NEUTRAL] OK, do you see anything that says inpatient?
[CUSTOMER][NEUTRAL] The group number is 2675 0 the policy certification, uh, I'm sorry. I see policy certification number is that what I'm needing to give you?
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] OK, it's 02569255.
[AGENT][NEUTRAL] OK, and if you can please verify your date of birth?
[AGENT][NEUTRAL] And mailing address.
[CUSTOMER][NEUTRAL] [PII], OK, [PII].
[CUSTOMER][NEUTRAL] And the mailing address is [PII].
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment. I do show the policy is active, effective date January.
[AGENT][NEUTRAL] And I do show.
[AGENT][NEUTRAL] Now, is this gonna be, cataracts is normally outpatient, correct?
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Yes, I won't be staying overnight in the hospital. Correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so I do show that um.
[AGENT][NEUTRAL] Now, to answer your initial question, we don't require authorization that's just something that the major medical has to.
[AGENT][NEUTRAL] That would be a major medical thing, but we don't require authorization, but I do show um that per day we cover $500 for outpatient.
[CUSTOMER][NEUTRAL] OK, so, um.
[CUSTOMER][NEUTRAL] So I need to go back and talk to the people who have my OPA regular uh South Carolina insurance to get authorization for cataract surgery.
[CUSTOMER][NEUTRAL] Is that right? Is that what you're telling me?
[AGENT][NEUTRAL] Um, that's who, that's who you're major.
[CUSTOMER][NEGATIVE] But you, you all are not the people that I need to talk to for that.
[AGENT][NEUTRAL] If that's who your major medical.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, are, are you still?
[AGENT][NEUTRAL] If that's who you're.
[CUSTOMER][POSITIVE] You're kind of coming in and out. I'm sorry.
[AGENT][NEUTRAL] OK, if that's who your major medical is, then that's, but normally, the provider, whoever's performing the surgery, they call to get authorization. It's, it's not.
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] Something that you're supposed to be doing.
[AGENT][NEUTRAL] Um, but I, I could be wrong. I don't know the guidelines of your major medical, but normally, the provider calls and gets the clearance for the surgery, but they will contact your major medical. They don't have to contact us cause we work in conjunction with the major medical. We're only the gap insurance, so we don't require authorization.
[CUSTOMER][POSITIVE] OK. All righty.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. All right. Thank you so much. OK.
[AGENT][NEUTRAL] OK, is there anything else I could assist with today?
[CUSTOMER][POSITIVE] I think that's it. Thank you.
[AGENT][POSITIVE] Thank you for calling APO you have a good day.
[CUSTOMER][NEUTRAL] Bye-bye.
[CUSTOMER][POSITIVE] Thank you.