AccountId: 011433970860
ContactId: c3caf04e-21ae-4ff0-85d6-5e383f241188
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 197500 ms
Total Talk Time (AGENT): 73060 ms
Total Talk Time (CUSTOMER): 103750 ms
Interruptions: 0
Overall Sentiment: AGENT=2.1, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/c3caf04e-21ae-4ff0-85d6-5e383f241188_20250414T17:50_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] Uh, hi, good morning. My name is [PII]. Last name starts with [PII], and I am calling from Genesis Healthcare Partners Gastroenterology department. I am calling to see if a mutual member requires a prior authorization to come into the facility.
[AGENT][NEUTRAL] OK, well, I can definitely help you with the authorization and [PII], may I have a um good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Uh yes ma'am. My a good call back number for myself it is going to be [PII], and then the members, um, their policy number, it is going to be 02595600.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Uh yes, member's name, it is going to be.
[CUSTOMER][NEUTRAL] Uh [PII], uh, date of birth is going to be [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. Um, so APL does not require any prior or pre-cert because we're not a major medical.
[CUSTOMER][NEUTRAL] OK, so then no authorization would be needed since like you stated, not a major medical?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] You, uh, not, not a a major medical plan? Is that, is that what the stands for?
[AGENT][NEUTRAL] Major medical in terms of Cigna, Blue Cross Blue Shield, Humana, we're not a commercial. We're a limited medical benefit or either it's a supplemental gap insurance, so we're not the major medical, the primary.
[CUSTOMER][NEUTRAL] OK, so if this is the only insurance the member provided to us, um.
[CUSTOMER][NEUTRAL] The member didn't provide a, a, a primary or a major medical insurance. This is the only one the member gave to us.
[AGENT][NEUTRAL] That's fine. Yes, that's fine, but as a company, APL doesn't require it because we're not a major medical insurance company.
[CUSTOMER][NEUTRAL] OK, I
[CUSTOMER][NEUTRAL] 00, OK, got it, understood. So the company doesn't require. OK then, so then, so then the member does not require a prior authorization, um, for the procedures that he's scheduled to come in through through this specific insurance plan.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Yes, ma'am. That's correct.
[CUSTOMER][POSITIVE] OK, thank you so much ma'am. I do appreciate your help today and I'm so sorry I did not catch your name in the beginning. What was your name again?
[AGENT][NEUTRAL] Oh, it's OK. My name is [PII], first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Thank you so much, [PII] and then can I get a reference number for our call today?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. Um, oh yeah, I already gave you the first initial. OK, that's it. That's my name and the date that I thought I missed something.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much [PII] have a good day today.
[AGENT][POSITIVE] Yes [PII], have a great week. Thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] You too bye bye.