AccountId: 011433970860
ContactId: c78d86b9-8bfc-4691-9e44-60a11f4d8bce
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 267899 ms
Total Talk Time (AGENT): 97228 ms
Total Talk Time (CUSTOMER): 122337 ms
Interruptions: 2
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/c78d86b9-8bfc-4691-9e44-60a11f4d8bce_20250512T15:06_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, is that [PII]?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Um, hi, my name is [PII]. I'm calling from Northeastern Health System. I'm calling to get, uh, benefits and eligibility for a patient. I'm also, um.
[CUSTOMER][NEUTRAL] Wanting to see if.
[CUSTOMER][NEUTRAL] The services will require a prior authorization.
[AGENT][NEUTRAL] OK, do you have a phone number I can get in case we get disconnected I can call you back?
[CUSTOMER][NEUTRAL] Yes, [PII] sorry [PII], yes.
[AGENT][NEUTRAL] [PII]. OK. And do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, it's gonna be 025.
[CUSTOMER][NEUTRAL] 793-35.
[CUSTOMER][NEUTRAL] And name is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Thank you, [PII]. Hold on one moment, please.
[CUSTOMER][NEUTRAL] Sure, oh yeah.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] OK, and what's the patient's name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] I can take
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII] and you wanted benefits and wanted to know if we require pre-authorization?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I can help you with that. We do not require pre-authorization. This is a secondary policy that coordinates with the primary insurance. Any benefits given over the phone is not a guarantee of payment. It coordinates with the primary, whatever the primary applies to their deductible co-pay or co-insurance is the only three things that we pick up, and is it for outpatient, inpatient or doctor's office?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] It's gonna be outpatient hospital.
[AGENT][NEUTRAL] OK, hold on one moment. Let me look that benefit up for you.
[CUSTOMER][NEUTRAL] I'll just need to get some initial bit of signature from you.
[AGENT][NEUTRAL] For outpatient we'll pay up to $3500.
[CUSTOMER][NEUTRAL] On a
[CUSTOMER][NEUTRAL] I'll be able to see
[CUSTOMER][NEUTRAL] Verify
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm sorry, is that like a deductible or a co-payment or?
[AGENT][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] No, ma'am, that's the max for the that we pay is 3500. Whatever the primary applies to their deductible, co-pay or coinsurance we'll pay up to $3500.
[CUSTOMER][NEUTRAL] I'll let you know when we get
[CUSTOMER][NEUTRAL] What is that
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] This one just stays
[CUSTOMER][NEUTRAL] belonging
[CUSTOMER][NEUTRAL] 3500 you said.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] the
[CUSTOMER][NEUTRAL] Information on either side
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And do you have an eligibility date?
[AGENT][NEUTRAL] It was effective [PII].
[CUSTOMER][NEUTRAL] Pathologist
[CUSTOMER][NEUTRAL] It's still active.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, and is there a call reference number?
[AGENT][NEUTRAL] We do not have call reference numbers. You can use my name and today's date. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] OK, um, yeah, I just wanted to be sure, so you guys cover the deductible from the primary?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, deductible, co-pay or co-insurance up to that 3500.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, that's all that I needed thank you so much.
[AGENT][POSITIVE] Thank you, [PII] for calling APL. You have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.