AccountId: 011433970860
ContactId: f598e4b1-5bed-4fa3-b6c3-ac524b35d1e3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 273890 ms
Total Talk Time (AGENT): 124801 ms
Total Talk Time (CUSTOMER): 53817 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/25/f598e4b1-5bed-4fa3-b6c3-ac524b35d1e3_20250625T12:17_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII], and I was calling to see if I need the authorization for a procedure code.
[AGENT][NEUTRAL] OK, [PII], you're wanting to find out if prior authorization is required on a member's policy? Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, ma'am, I can help you with that. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and what is the member's policy number, please?
[CUSTOMER][NEUTRAL] I have 02596460.
[AGENT][NEUTRAL] OK thank you one moment while I get the member's information pulled up.
[AGENT][NEUTRAL] And [PII], any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you. So on this limited benefit plan that she has, no, ma'am, prior authorization is not required.
[AGENT][NEUTRAL] Now if you all end up filing a claim.
[CUSTOMER][NEUTRAL] OK, and she does have surgery benefits.
[AGENT][NEUTRAL] Oh, I'm sorry, I didn't realize you needed surgery uh needed benefits as well.
[CUSTOMER][NEUTRAL] Yeah, I mean, it does, does she have the surgery benefits on there cause this is a surgical procedure.
[AGENT][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] I can check that, just a moment.
[AGENT][NEUTRAL] Is this gonna be done at a facility or in an office setting?
[CUSTOMER][NEUTRAL] Um, facility.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so on this limited benefit plan, [PII], for accident and sickness surgery, the benefit would be $500 per day, maximum of 1 day per calendar year per covered person.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so this procedure will be covered under that. Do you need a procedure code or anything?
[AGENT][NEUTRAL] I cannot guarantee payment of benefits. We will just have to receive the claim for review. What I can tell you is that the benefit amount on this plan for accident and sickness.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] For surgery is $500 per day and a maximum of 1 day per calendar year per covered person.
[CUSTOMER][NEUTRAL] OK, so it covers $500 for one day.
[AGENT][NEUTRAL] That is correct, per calendar year per covered person.
[CUSTOMER][NEUTRAL] OK, alright, and then you said no authorization was needed for anything outpatient?
[AGENT][NEUTRAL] got anything on this policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am, and then [PII], what I was going to say is that if, if you all end up filing a claim for this member once the claim has been processed, we do have a portal in which you should be able to check claim status and and the portal websites located at [PII]
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, alright, is there a reference number for this call?
[AGENT][NEUTRAL] You would use my name that I gave you along with today's date.
[CUSTOMER][POSITIVE] Alright, thank you.
[AGENT][POSITIVE] Well, you're very welcome. And again, is there anything else I can help you with this morning?
[CUSTOMER][NEUTRAL] That's it.
[AGENT][POSITIVE] OK, well then, thank you so much for calling APL and I hope you have a very nice day.
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.