AccountId: 011433970860
ContactId: eed832b9-6d67-49c7-bdc9-0a43686e3810
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 194440 ms
Total Talk Time (AGENT): 106915 ms
Total Talk Time (CUSTOMER): 164030 ms
Interruptions: 14
Overall Sentiment: AGENT=1.9, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/eed832b9-6d67-49c7-bdc9-0a43686e3810_20250305T19:55_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APM. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] You know what I mean, you know, whether it's a tax or. Hi [PII] I'm calling to check um benefits for this patient, so he's having outpatient surgery next week and um he just gave us this information so I'm trying to verify if authorization is required and how it's gonna be covered. My name is [PII]. Last initial is [PII].
[AGENT][NEUTRAL] Hi.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. May I have your name?
[AGENT][POSITIVE] Thank you so much [PII], and may I also have your callback number?
[CUSTOMER][NEUTRAL] OK, to um get that [PII].
[AGENT][POSITIVE] Thank you very much. And [PII], what is the policy number, please?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] It is 02572772. What it's dispatch it you're gonna put the patch it's CSRs. I have patient [PII] and then A N D R A D E 71,070.
[AGENT][POSITIVE] Thank you very much and to repeat and confirm I have that as 025727772.
[AGENT][NEUTRAL] Thank you and verify the patient's name and date of birth.
[AGENT][POSITIVE] Thank you so much and you're calling to check if pre-authorizations are required and what the outpatient benefits are for surgery outpatient, OK?
[CUSTOMER][NEUTRAL] It's uh applicable, the service order and then obviously the lunch, OK.
[CUSTOMER][NEUTRAL] Right, what department has the coaching opportunity.
[AGENT][NEUTRAL] Give me one second here. Now we'll go ahead and tell you that there are no pre-certs or pre-authorizations that are required on any of our policies, and let me get those benefits for outpatients. Please note verification of benefits provided does not guarantee payment. Um, this policy shows effective for the member as of [PII].
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] It's um, it's not letting me obviously the designers fill up, you know, you know, in the front page, right? So that's what you do when you have again if there's a customer that calls in complaining about a tax, right? Not necessarily those you don't need to escalate those to the seniors. You could just, if they just wanna back now if they have to speak to a manager supervisor, they need to fax a CCL to the senior. However, it was just.
[AGENT][POSITIVE] And bear with me please, [PII], thank you.
[AGENT][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] OK, the outpatient max we will pay up to $3750 and that's per calendar year. I'm sorry, give me one moment, give me one second please.
[CUSTOMER][NEUTRAL] For example, um.
[CUSTOMER][NEUTRAL] Yes, you could put the technician, OK, it applies to any other department as well, OK? So uh what I'm gonna do is I am going to. So whatever the claim is sent, he's covered from you guys at least $1250.
[AGENT][NEUTRAL] Bear with me.
[AGENT][NEUTRAL] My apologies, let me correct myself. That will be $1250 for the calendar year.
[AGENT][NEUTRAL] Uh, we pay up to $1250 of course, and we help with his major medical deductible, co-pay and or co-insurance based on coverage and of course, um, that max we'll pay for all covered outpatient services will be $1250.
[CUSTOMER][NEGATIVE] You're not gonna, I don't think you're gonna have access to this because the owner of this channel is just, you know, um, if you do the control app.
[CUSTOMER][POSITIVE] Yeah, that would be amazing.
[AGENT][NEUTRAL] If you like, I can check to see if anything has been accumulated.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, nothing has been accumulated for that outpatient max or towards the outpatient max.
[CUSTOMER][POSITIVE] We're gonna be like, you know, because there's a lot of stuff that we can.
[CUSTOMER][NEUTRAL] OK. And what's the name of this insurance?
[AGENT][NEUTRAL] This is APL or American Public Life.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] It's a supplemental, yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][POSITIVE] Perfect. All right. Thank you so much for all your help.
[AGENT][POSITIVE] You're welcome [PII]. Thank you for calling APL. You have a great day. Thank you.
[CUSTOMER][NEUTRAL] Yeah. You too, bye bye.
[AGENT][NEUTRAL] Bye.