AccountId: 011433970860
ContactId: bf98b28f-7457-42ae-a612-e502e85b46a6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 223630 ms
Total Talk Time (AGENT): 93441 ms
Total Talk Time (CUSTOMER): 86633 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/bf98b28f-7457-42ae-a612-e502e85b46a6_20250107T23:23_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], how are you? My name is [PII].
[CUSTOMER][NEUTRAL] I have a procedure schedule for tomorrow.
[AGENT][POSITIVE] I'm good, [PII].
[CUSTOMER][NEUTRAL] And I wanna make sure that you know that um that we already have the pre-approval to to proceed with the procedure.
[AGENT][NEUTRAL] Alright, let me take a look at your policy. Do you have a policy number with us?
[CUSTOMER][NEUTRAL] Yes, the policy certificate number is 948722.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, let me just pull this up here, one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And if I could verify, please, your date of birth and address?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] All right, thank you so much. So this is your secondary plan. So no pre no, no pre-authorization is needed for any sort of procedure that you're going to have done. This is going to cover any deductible, co-pay or co-insurance that your primary does not. If it's an outpatient uh surgery, your outpatient benefits for the calendar year or a maximum of $2000.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh, yeah, I mean.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I would just make certain that when you go for the procedure,
[CUSTOMER][NEUTRAL] Oh, let me see, let me see, how do I know, how do I know if this, how do I know if this procedure is outpatient or inpatient or or inpatient? I don't know.
[AGENT][NEUTRAL] Are you gonna be in the hospital for over 18 hours?
[CUSTOMER][NEUTRAL] How do I
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, so it would be considered outpatient.
[CUSTOMER][NEGATIVE] They're gonna do, they're gonna, they're gonna put a, uh like, like a pain shot in my, in my back, in my spine.
[AGENT][NEUTRAL] OK. So when you
[CUSTOMER][NEGATIVE] But they have to put me to sleep.
[AGENT][NEUTRAL] When you go for the procedure just give them your primary insurance and then give them the insurance card for us and just let them know that we're the secondary insurance so they should bill your primary insurance first and then after that pays they they would bill us for the residual.
[CUSTOMER][NEUTRAL] I understand.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Well, that's the thing. I mean, um, right now, right now my deductible is full because obviously, uh the year just started, so it's at 0.
[CUSTOMER][NEUTRAL] So basically you guys will be the ones covering the whole team that's the reason why I'm calling for this.
[CUSTOMER][NEUTRAL] I don't know if you, if you can understand what I'm saying. I mean, you know, it's the beginning of the year. I haven't done anything yet, so my.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] My full uh deductible is due.
[CUSTOMER][NEUTRAL] So they won't pay for the 1st $2000 of the procedure, so you guys will have to cover that.
[AGENT][NEUTRAL] OK, so that would be then covered once the procedure and the claim has been then submitted, yes.
[CUSTOMER][NEUTRAL] OK, and you guys cover that type of procedure?
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] That's basically my question.
[AGENT][NEUTRAL] Yes, so this will, yes, this will cover a procedure that is outpatient, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, with anesthesia and everything, right?
[AGENT][NEUTRAL] Yes, it will, uh huh.
[CUSTOMER][POSITIVE] All right, thank you so much I really appreciate it thanks.
[AGENT][NEUTRAL] Mhm. Bye-bye.
[CUSTOMER][POSITIVE] Bye thanks.