AccountId: 011433970860
ContactId: ff1d650c-4284-4cbc-86a7-b440134df251
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 200520 ms
Total Talk Time (AGENT): 83500 ms
Total Talk Time (CUSTOMER): 85367 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/ff1d650c-4284-4cbc-86a7-b440134df251_20250415T19:15_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], this is [PII] with Midtown Women's Center. Um, I have a patient that we have scheduled for surgery, and I just need to verify her benefits and eligibility for that.
[AGENT][POSITIVE] OK, yeah, happy to help on benefits and eligibility care. Can I get the policy number if you have it?
[CUSTOMER][NEUTRAL] I do it's 021411171.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you for that. Let me pull this up here.
[AGENT][NEUTRAL] And do you have a good callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] What is the patient name and date of birth, please?
[CUSTOMER][NEUTRAL] Uh, that is [PII] and her birth date is [PII].
[AGENT][POSITIVE] Thank you so much. So policy is active. Uh, the effective date on here is [PII]. We are the member of secondary insurance, so this is going to cover deductible, co-pay, co-insurance. The primary does not.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then is patient gonna be seen on an in did you want the inpatient benefits or outpatient?
[CUSTOMER][NEUTRAL] Uh, this will be, uh, outpatient is the initial plan.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, the outpatient benefit max for the calendar year is $5000.
[AGENT][NEUTRAL] That's the same actually for the inpatient also.
[AGENT][NEUTRAL] They haven't used anything this year it looks like.
[CUSTOMER][NEUTRAL] OK, so we filed to the primary, uh, the primary does have a $5000 deductible, so in essence you're going to cover up to that $5000 whosever claims come to you first, and then once the $5000 is exceeded for outpatient related services, then there's no further coverage.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Correct, it would be exhausted at that point.
[CUSTOMER][POSITIVE] Got you OK.
[CUSTOMER][NEUTRAL] Uh, benefit mac that's not that out of pocket. OK, uh, that, oh, it's outpatient. I can't remember what my OP was outpatient nothing used so far.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And it doesn't matter uh whether it's the hospital, the doctor, the anesthesia, any, it's any of those.
[AGENT][NEUTRAL] Right, yeah, it would just, it just falls basically under the umbrella of outpatient. Yeah, absolutely.
[CUSTOMER][NEUTRAL] Providers OK.
[CUSTOMER][NEUTRAL] OK, and then do you require prior authorization?
[AGENT][NEUTRAL] No, ma'am, not required.
[CUSTOMER][POSITIVE] Perfect
[CUSTOMER][NEUTRAL] And can I get a reference number, sir?
[AGENT][NEUTRAL] Absolutely. So call reference is going to be my name, my last initial, and then today's date. My name is [PII] spelled [PII] My last initial is [PII], and today's date is [PII].
[CUSTOMER][POSITIVE] Thank you so much you have a great day.
[AGENT][POSITIVE] You too. Take care.
[CUSTOMER][NEUTRAL] Mhm bye bye.