AccountId: 011433970860
ContactId: e8cc6c0f-f84b-4acd-9829-b8aa5a9b8a90
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 238270 ms
Total Talk Time (AGENT): 110729 ms
Total Talk Time (CUSTOMER): 90939 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/06/e8cc6c0f-f84b-4acd-9829-b8aa5a9b8a90_20250306T16:16_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hi, [PII]. My name is [PII]. I'm calling from Park Creek Surgery Center. I'm calling for eligibility and benefits for a patient for outpatient surgery and ambulatory, uh, from an ambulatory center.
[AGENT][POSITIVE] OK. Well, I can definitely assist you with the outpatient surgery benefits. And [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Oh sure, that would be [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number?
[CUSTOMER][NEUTRAL] That would be.
[CUSTOMER][NEUTRAL] I guess it's 02152694 M as in Mary, L as in Lima 8.
[AGENT][NEUTRAL] Thank you. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure, that would be um [PII] date of birth of [PII].
[AGENT][NEUTRAL] Thank you, and all the information provided is a verification of benefits, not a guarantee of payment. So I am showing that the policy is active. It's been effective since [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] And hold on one moment. I'm getting the outpatient benefits for you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So for outpatient, the policy will pay up to $3000 per calendar year. That does include um surgery in an outpatient facility or freestanding um hospital outpatient facility. And did you want me to see if any of the 3000 has been used for this year?
[CUSTOMER][NEUTRAL] 6
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEGATIVE] And none of the benefits have been used this year.
[CUSTOMER][NEUTRAL] None.
[AGENT][NEGATIVE] Right, for outpatient, none of the benefits have been used.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, they are used and what type of plan is this?
[AGENT][NEUTRAL] So this is their Metlink, um, so it's a supplemental gap insurance, we pay towards the copay, deductible and co-insurance of coverage charges after their primary UnitedHealthcare.
[CUSTOMER][NEUTRAL] OK, so, uh, we coordinating benefits with United Healthcare, you would pick up the, um, the, uh, I'm sorry, patients coinsurance.
[AGENT][NEUTRAL] Right, so we can pay towards that if it's a cover charge, yes, we can pay towards the co-insurance, the deductible, or the co-pay up to that $3000 per year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK then is there any authorization required?
[AGENT][NEUTRAL] Um, no, ma'am. There's no prior author precert required because we're not a major medical insurance company.
[CUSTOMER][NEUTRAL] OK then.
[CUSTOMER][NEUTRAL] Not required right then [PII], uh, is [PII] or [PII]?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII], OK, and I, can I get the first initial of your last name for my records?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Sure, it's [PII].
[CUSTOMER][NEGATIVE] And this patient doesn't have a deductible out of pocket, it's just a $3000 cap.
[AGENT][NEUTRAL] Let me double check just to make sure. Some of them do have deductibles, but I didn't think, no, this one doesn't have a deductible. So it's just a $3000 max for the year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK then
[CUSTOMER][NEUTRAL] Mm OK, $3000 mark for the year. Alrighty then, and I think that's all that I need. Uh, can I get a reference number for the call?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then my first name is [PII]
[CUSTOMER][NEUTRAL] Alright then
[CUSTOMER][POSITIVE] Thank you [PII] thank you very much for your time and patience I appreciate it.
[AGENT][POSITIVE] You're very welcome. Well, thanks for calling APL Madeline. I hope you have a great day.
[CUSTOMER][POSITIVE] You as well thank you.
[AGENT][POSITIVE] Thank you, you're welcome. Bye bye.
[CUSTOMER][NEUTRAL] Mm mm bye.