AccountId: 011433970860
ContactId: e9bea6cc-de7f-49bc-aa34-078dfa6308b8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 321059 ms
Total Talk Time (AGENT): 84633 ms
Total Talk Time (CUSTOMER): 116204 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/e9bea6cc-de7f-49bc-aa34-078dfa6308b8_20250411T16:02_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] and I need to see if a prior authorization is required for an outpatient procedure for a patient and also check their eligibility if I can.
[AGENT][NEUTRAL] OK, [PII], I can help you with eligibility. Um, we do not require prior off for any procedures. And then what is a good callback number for you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Mhm. It is D as in dog, 43722079.
[AGENT][NEUTRAL] Um, do you have their last name or social?
[CUSTOMER][NEUTRAL] Uh-huh. Last name is [PII], and let me see, I might have their social on the demographics here. Let's see.
[CUSTOMER][NEUTRAL] Uh, yes. So, excuse me, [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, and the last name was [PII], is that correct?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII], it's her first name.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] No, I'm not pulling up that social or name in our system. Do you have a group number?
[CUSTOMER][NEUTRAL] Uh, let me go back to her card that I have.
[CUSTOMER][NEUTRAL] Documents.
[CUSTOMER][NEUTRAL] Um, here's your card.
[CUSTOMER][NEUTRAL] It says um, it must be through her husband. It's got an insured employee's name, employee and spouse, and then it's got policy cert number, is that the one that I gave you? Let me go back.
[AGENT][NEUTRAL] Uh, yeah, let me see the policy er number.
[CUSTOMER][NEUTRAL] OK, it's 02596440.
[AGENT][NEUTRAL] OK, I've got it pulled up now. OK. And what was her date of birth?
[CUSTOMER][NEUTRAL] OK. Um, [PII].
[AGENT][POSITIVE] OK, perfect
[AGENT][NEUTRAL] OK, and we needing benefits or just eligibility?
[CUSTOMER][POSITIVE] Um, yeah, I'll take the benefits too if you don't mind.
[AGENT][NEUTRAL] OK. Is this for outpatient services or doctor's office visit or?
[CUSTOMER][NEUTRAL] It's an outpatient heart cath.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I show the policy is effective [PII]. It's currently active.
[AGENT][NEUTRAL] Um, let me look at the benefits, not a guarantee of payments, a basic outline of the policy.
[AGENT][NEUTRAL] OK, so we have.
[AGENT][NEUTRAL] Is that typically considered surgery? Is that what that is?
[CUSTOMER][NEUTRAL] It is, mhm.
[AGENT][NEUTRAL] OK, so this is a hospital indemnity plan, so it's like a limited plan for um surgery in a hospital, it's a $500 per day payout and a maximum of 1 day per calendar year.
[CUSTOMER][NEUTRAL] OK, 500 per day payout and 1 day per calendar year.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And are you able to tell me if she's had her one day yet?
[AGENT][NEUTRAL] Uh, let me look. Uh, hold on one moment.
[CUSTOMER][NEUTRAL] Limited plan.
[AGENT][NEUTRAL] Uh, don't show anything's been used.
[CUSTOMER][NEUTRAL] OK, 0 used and you said there's no prior off required.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, and will there be a call reference number for today?
[AGENT][NEUTRAL] Um, it's just my name, [PII], first initial to last name, [PII], and today's date.
[CUSTOMER][POSITIVE] OK, perfect. I appreciate your help, [PII]. Have a good day.
[AGENT][POSITIVE] OK, thanks for calling APL. Have a great weekend.
[CUSTOMER][NEUTRAL] Bye bye you too.