AccountId: 011433970860
ContactId: c459389c-6612-498b-91f8-270b5a5a89ea
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 362570 ms
Total Talk Time (AGENT): 153822 ms
Total Talk Time (CUSTOMER): 108340 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/12/c459389c-6612-498b-91f8-270b5a5a89ea_20250612T17:30_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] Hey, my name is [PII]. I'm calling from Emed. How are you doing today?
[AGENT][POSITIVE] I'm doing well, [PII]. How are you?
[CUSTOMER][POSITIVE] Good. I'm
[CUSTOMER][NEUTRAL] Alright, so I'm trying to see.
[CUSTOMER][NEUTRAL] OK, I'm trying, I'm calling from the financial department here at the hospital. I'm trying to see if two procedures require authorization.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, I can
[CUSTOMER][NEUTRAL] And then I talked to um I'm [PII] and she sent me to you.
[AGENT][POSITIVE] OK, um, well, I'll be more than happy to assist you. um, and [PII], may I have a good contact number in case we're disconnected and then the member's policy number, so you just want to know if all is needed.
[CUSTOMER][NEUTRAL] That and then like I probably need his benefits too.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so yeah, his my callback, wait, do you need my callback number you said?
[AGENT][NEUTRAL] Yes, call back and then his policy or he or she's policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so my apo my callback number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And then on the card.
[CUSTOMER][NEUTRAL] I have his policy number as D43732506.
[AGENT][NEUTRAL] Do you see anything on the card that says policy cert number?
[AGENT][NEUTRAL] It should start with a 01 or 02. Mhm.
[CUSTOMER][NEUTRAL] Give me a minute.
[CUSTOMER][NEUTRAL] Hang on.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK, um, so that the number is the, the policy number for 90 Degree benefits. Um, do you have the member's full social? I can look the policy up that way.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm, yeah, let me call in and get it, hang on, hang on.
[AGENT][POSITIVE] Mhm. Take your time.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And what is the name, the member's first and last name?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And this is for his medical policy, correct?
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] All right. So the policy number is 257.
[AGENT][NEUTRAL] 6448. OK.
[CUSTOMER][NEUTRAL] Hang on one second.
[CUSTOMER][NEUTRAL] Yes, I see, and I have that in my epic, but his card says something different, but OK.
[AGENT][NEUTRAL] Yeah, he, that's that's um the card that he has sounds like the 90-degree card, not the APL card, but it's OK, um, long as you have it and the um the policy has been effective since [PII].
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so there, none of the APL policies require prior art or pre-cert because we're not a major medical insurance company.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] But I can definitely go over the benefits of the policy with you if you like.
[CUSTOMER][NEUTRAL] Uh-huh, yeah, um, so, yeah, I just need his benefits.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] OK, um, so are you all like considered outpatient, inpatient? What type of, what, what's he having?
[CUSTOMER][NEUTRAL] So this, yeah this is for an outpatient procedure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you mind if I place you on just a brief hold? I'm just waiting for the benefits to pop here.
[CUSTOMER][NEUTRAL] No, you're fine. You're fine. Mhm.
[AGENT][NEUTRAL] Alright, thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK. You are on hold.
[AGENT][NEUTRAL] I just wanna make sure I'm understanding this correctly.
[AGENT][NEUTRAL] Oh, let's see.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] All right, thanks so much for holding. I apologize for the wait. So the policy doesn't have any um coverage for outpa. So first is a hospital indemnity policy, so it's a limited policy, but it doesn't have any coverage for the outpatient um facility other than surgery um in a hospital.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, it's an outpatient surgery.
[AGENT][NEUTRAL] Oh, it's a surgery. OK, so the policy will pay up to $500 per day, with a max of 1 day per calendar year towards the surgery. If it's in a physician office, the policy will pay up to $125 per day, with a max of 1 day per calendar year for the surgery.
[CUSTOMER][NEUTRAL] All right, so basically they just pay $500 towards the procedure.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Alrighty, and do you have a call reference number by any chance?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date, and again, that's [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alrighty, thank you, [PII], you have a great day.
[AGENT][POSITIVE] Alrighty
[AGENT][POSITIVE] You're welcome, [PII]. Was there anything else I can help with?
[CUSTOMER][POSITIVE] Thanks.
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] Alright, thanks for calling APO bye bye.
[CUSTOMER][POSITIVE] Thank you, bye bye.