AccountId: 011433970860
ContactId: f3111eae-d398-4343-adac-a3f92564cefc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 295100 ms
Total Talk Time (AGENT): 140500 ms
Total Talk Time (CUSTOMER): 78181 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/07/f3111eae-d398-4343-adac-a3f92564cefc_20250407T15:00_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi, I'm not sure if I'm in the right place. I'm calling from Southside Medical Center and I was calling to get prior authorization.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, you're wanting to find out about prior authorization for a member, is that correct?
[CUSTOMER][NEUTRAL] Yes, mhm.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Can you please spell your name for me?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, [PII]. Thank you. And your callback number, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] One more time.
[AGENT][NEUTRAL] The member's policy number?
[CUSTOMER][NEUTRAL] It is 026.
[CUSTOMER][NEUTRAL] 07096
[AGENT][NEUTRAL] OK, thank you, [PII]. Give me a couple of moments please to get the member's information pulled up.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] We
[AGENT][NEUTRAL] OK [PII], so any information that I do provide will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Date of birth [PII].
[AGENT][NEUTRAL] OK, thank you. So do you, you already have eligibility for her or do you also need that?
[CUSTOMER][NEUTRAL] No, I believe I have eligibility. I just need prior authorization.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, sure. So because this is a supplemental policy to her primary insurance, there is no prior authorization required with APL.
[AGENT][NEUTRAL] But when the claim is submitted to us for review, we must also receive a copy of her primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] And then Jermaa once we have processed.
[CUSTOMER][NEUTRAL] So you said her primary insurance?
[AGENT][NEUTRAL] Yes, ma'am. We're supplemental policy only.
[CUSTOMER][NEUTRAL] So she does not have any primary insurance.
[AGENT][NEUTRAL] She would have to have primary insurance in order to have this coverage.
[AGENT][NEUTRAL] Again, we are a supplement to her primary insurance.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] To
[CUSTOMER][NEUTRAL] OK, and then also can I get that one more time after you said the supplements to primary insurance?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] That she would need prior she still wouldn't need.
[AGENT][NEUTRAL] We are not
[AGENT][NEUTRAL] OK. She will not, there is no prior authorization required with APL.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Because of it being a supplemental policy, it would follow whatever her primary insurance is.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] We show her major medical to be with [PII].
[AGENT][NEUTRAL] But when the claim is submitted to APL for review, we will have to have a copy of her primary insurance company's explanation of benefits.
[AGENT][NEUTRAL] As well.
[AGENT][NEUTRAL] And then once we have processed our claim here at APL, we do have a portal that you should be able to check her claim status in by going to [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] [PII].
[AGENT][NEUTRAL] [PII]. Yes, ma'am.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] All right. Well, is there anything else that I can help you with, [PII]?
[CUSTOMER][POSITIVE] No ma'am, that'll be all for me thank you.
[AGENT][POSITIVE] Well, you are certainly very welcome and thank you for calling APL. I hope you have a wonderful day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You do the same.
[AGENT][POSITIVE] Yes, ma'am. Thank you.
[CUSTOMER][POSITIVE] You're welcome bye bye.
[AGENT][NEUTRAL] Mhm