AccountId: 011433970860
ContactId: 0aed36be-d882-4914-b641-47fd6d592364
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 262519 ms
Total Talk Time (AGENT): 85515 ms
Total Talk Time (CUSTOMER): 44613 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/0aed36be-d882-4914-b641-47fd6d592364_20250128T15:39_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] and I'm calling to um see if prior office is required for an outpatient procedure for a patient and check the eligibility and benefits for it.
[AGENT][NEUTRAL] OK. And so it's being done in a hospital or facility setting?
[CUSTOMER][NEUTRAL] Yes, outpatient hospital.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And what's the policy number?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Let me go back because it gives me um 2,371,130.
[AGENT][NEUTRAL] And what's a good phone number in case we're disconnected [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Thank you for that information. um, so we're checking eligibility, um, outpatient benefit and then a prior authorization is required, correct?
[CUSTOMER][NEUTRAL] Yes, mhm.
[AGENT][NEUTRAL] Alright, so I'm showing an effective date of [PII], uh, that do show the policy is active at this time.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] I'm sorry, did you say that this is a surgical procedure?
[AGENT][NEUTRAL] Or not?
[CUSTOMER][NEUTRAL] No, it's a, mm mm, no, it's a CT scan, so a diagnostic radiology.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, got it. Thank you. One moment.
[AGENT][NEUTRAL] I'm looking at the policy here.
[AGENT][NEUTRAL] All right, so.
[AGENT][NEUTRAL] There is a medical imaging test benefit under the policy and a CT scan is one that is covered.
[AGENT][POSITIVE] And the benefit for that.
[AGENT][NEUTRAL] Uh, per the policy is $100 per day.
[AGENT][NEUTRAL] A maximum of 2 days per calendar year per covered person.
[AGENT][NEUTRAL] And let's see, let me look at the history.
[AGENT][NEUTRAL] I don't show any claims for [PII] at this time.
[AGENT][NEUTRAL] And prior authorization is not required.
[CUSTOMER][NEUTRAL] And will there be a call reference number?
[AGENT][NEUTRAL] It's my name in today's date, [PII] last name is [PII] and information provided is verification, not a guarantee of payment [PII] until we receive the actual claim documentation. And did you have any other questions I can assist with today?
[CUSTOMER][POSITIVE] No, that's all. I appreciate your help. Have a good day.
[AGENT][POSITIVE] Oh, you're welcome. You too. Thank you for calling APL have a good day.