AccountId: 011433970860
ContactId: c29f7b80-0e93-4b06-95d6-1b74d44b165f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 368450 ms
Total Talk Time (AGENT): 158750 ms
Total Talk Time (CUSTOMER): 154964 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/c29f7b80-0e93-4b06-95d6-1b74d44b165f_20250410T15:11_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII].
[AGENT][NEUTRAL] How can I help you?
[CUSTOMER][NEUTRAL] Hi, sorry.
[CUSTOMER][NEUTRAL] Hi [PII], good morning. My name is [PII]. I'm calling you with Valley Woman's Healthcare, and I wanted to see if you can help me with the patient that we're trying to, um, get in to do an outpatient surgery for. Um, just wanna see if she has, uh, benefits and if I need to do a prior authorization.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, I can help you with benefits and prior authorization Miss [PII] can I please get your callback number just in case the call gets disconnected?
[CUSTOMER][NEUTRAL] Yes, please. It's [PII].
[AGENT][NEUTRAL] Thank you. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yes, so her first name is uh [PII]. Uh last name is spelled [PII] and um date of birth [PII] and her policy number is 02494078.
[AGENT][NEUTRAL] OK, let me look up her policy real quick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I do show that she does have an active policy.
[AGENT][NEUTRAL] And her effective date is [PII].
[AGENT][NEUTRAL] And this is just to verify her benefits. It's not a guarantee of payment.
[AGENT][NEUTRAL] She has um a hospital plan.
[AGENT][NEUTRAL] Are you able to hear me?
[CUSTOMER][NEUTRAL] Um, sorry, you cut out a little bit. She has, you said she has a hospital.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Oh, I
[AGENT][NEUTRAL] Yes, she has a hospital indemnity plan. Um, I'm looking now to see as far as uh benefits go.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is she going to be outpatient or inpatient for her surgery?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's gonna be an outpatient.
[AGENT][NEUTRAL] Outpatient surgery. OK, let me look real quick.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I'm gonna pull up her policy and see if outpatient surgery is um.
[AGENT][NEUTRAL] Covered
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] OK, what does hospital indemnity mean, by the way?
[AGENT][NEUTRAL] Oh, she does
[AGENT][NEUTRAL] Hospital indemnity is a set amount for a covered procedure. So there's a set amount rather than a, a percentage.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] For a covered procedure. Now, she does have um accident and sickness surgical benefit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] In a surgical facility.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this is like I said just to verify her benefits it's not a guar guarantee of payment she has one per calendar year that covers $250.
[AGENT][NEUTRAL] For accident or sickness.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, cause, so basically with um her mhm.
[AGENT][NEUTRAL] And she will
[AGENT][NEUTRAL] Uh-huh. She will not need a prior. That's OK. She will not need a prior authorization as this is not the major medical insurance.
[CUSTOMER][NEUTRAL] Sorry. No, I was just gonna.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Let's see, OK, because her situation is she's having a miscarriage and we were gonna do a D&C. So I don't know if that's considered an accident or.
[AGENT][NEUTRAL] Right, so
[AGENT][NEUTRAL] Yes, that's, um, pregnancy is considered sickness, believe it or not. So, yes, um.
[CUSTOMER][NEUTRAL] OK. Oh, OK.
[AGENT][NEUTRAL] Right. So, if she does have that surgical benefit at a surgical facility, one per calendar year.
[AGENT][NEUTRAL] And it uh pays $250.
[CUSTOMER][NEUTRAL] So, OK. So she has the procedure done, um,
[CUSTOMER][NEUTRAL] And it's considered sickness because it's pregnancy related, um, but it, it's being done at an outpatient hospital and not like an actual like ambulatory surgery center. Is that still?
[CUSTOMER][NEUTRAL] Considered a surgery facility or?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, and then if she has the procedure done, you guys, um, this insurance plan will only cover.
[CUSTOMER][NEUTRAL] $250 of it.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and then would the remaining balance be billed to the patient?
[AGENT][NEUTRAL] We don't give patient responsibility. We let the provider determine that.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Oh, OK, OK, OK, but, but the plan period just only covers $250. They don't have like a co-insurance or anything like that.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Understandable. OK. So, um, I guess this is what I needed. Um, and [PII], do you have a call reference number?
[AGENT][NEUTRAL] Yes ma'am, you can use my name and today's date.
[CUSTOMER][NEUTRAL] And that's [PII]?
[AGENT][NEUTRAL] It's a [PII]
[CUSTOMER][POSITIVE] OK, perfect. OK, [PII], well thank you so much for your help with this. Um, if there's any further questions, I'll have the hospital reach out, um, in case they need to ask any more questions, but thank you so much.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're very welcome, Ms. [PII], and I hope you have a wonderful day. We thank you for calling APL.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][POSITIVE] Yes, thank you so much. Bye.
[AGENT][NEUTRAL] Hm
[AGENT][POSITIVE] You're welcome. Bye-bye, ma'am.
[CUSTOMER][NEUTRAL] Bye.