AccountId: 011433970860
ContactId: 03aca454-93b0-4802-bee7-811a80faa4dc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 180179 ms
Total Talk Time (AGENT): 112426 ms
Total Talk Time (CUSTOMER): 48847 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/03aca454-93b0-4802-bee7-811a80faa4dc_20250127T16:55_UTC.wav
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[AGENT][NEUTRAL] Contacting APL, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] I'm calling from Doctor [PII]'s office. I'm calling to see if prior authorization is required for some pain management procedures.
[AGENT][NEUTRAL] I can certainly look that up, [PII]. What is the policy number, please?
[CUSTOMER][NEUTRAL] Um, do you want his employee ID number or?
[AGENT][NEUTRAL] No, it's uh, it should list a uh a uh
[AGENT][NEUTRAL] Policy number may be beginning with 01 or 02.
[CUSTOMER][NEUTRAL] OK, 02544385.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] [PII] [PII] [PII].
[AGENT][POSITIVE] Thank you very much. Is there a callback number I can have the event that we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Yes, thank you very much. The policy doesn't have a pre-authorization. Um, this is a, uh,
[AGENT][NEUTRAL] These policies are um limited benefits, hospital indemnity policies, uh.
[AGENT][NEUTRAL] They don't, uh, they're not the same as major medical, so they don't really require a pre-authorization um for those to, to be, uh, to be processed. So, so no, pre-op is not needed on anything on, on these. And what, um, could you tell me exactly what is being done because otherwise, it because it's, some of the things are not, uh, some things are, are covered and some things are not.
[CUSTOMER][NEUTRAL] Um, this is a medial branch block, the, um.
[CUSTOMER][NEUTRAL] Like a test injection before we do like a burning of the nerves type of thing.
[AGENT][NEUTRAL] OK, well, is it for the
[CUSTOMER][NEUTRAL] The CPT code would be 646 I'm 64493 and 64494.
[AGENT][NEUTRAL] OK, OK. Um, if it's done in a physician's office, um, no, they do have
[CUSTOMER][NEUTRAL] Can be done in an outpatient hospital.
[AGENT][NEUTRAL] OK. OK. So, uh, outpatient hospital, uh, surgery in an outpatient hospital or the outpatient, um, uh, facilities, just the whole procedure, we will pay up to $500 for that for one procedure per calendar year. That's just a verification of the benefits, not a guarantee of payment, but that's the way that the policy works. It has a flat rate benefit that it pays um for uh.
[AGENT][NEUTRAL] For um like a hospital visit or um there's a certain amount they'll pay for an office visit. They have two of those throughout the calendar year, but that's what this does. But there, but there is no pre-authorization, [PII], it's just um you just send your claim in and it pays that flat be that flat benefit.
[AGENT][NEUTRAL] That flight rate benefit.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Is there any anything else at all I can help with?
[CUSTOMER][NEGATIVE] Uh, no, I don't believe so.
[AGENT][POSITIVE] OK, well thank you for contacting AP.