AccountId: 011433970860
ContactId: 3e2f4cd6-2fd2-4946-8f55-2542fe5304e3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 408799 ms
Total Talk Time (AGENT): 149164 ms
Total Talk Time (CUSTOMER): 170859 ms
Interruptions: 2
Overall Sentiment: AGENT=1.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/3e2f4cd6-2fd2-4946-8f55-2542fe5304e3_20250428T18:04_UTC.wav
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[AGENT][NEUTRAL] This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hey, hi. My name is [PII] Initial to my last name is [PII], calling you on behalf of doctor's office to verify precertification requirements for the CPT code. Please be advised that the call is recorded for quality and monitoring purposes.
[AGENT][NEUTRAL] Can I have a callback number for you and that policy number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, our callback number is [PII]. It's a direct line.
[AGENT][NEUTRAL] And what is the policy number of the member that you're calling to verify benefits for today?
[CUSTOMER][NEUTRAL] Yeah, the member's member's ID number is 02187726.
[AGENT][NEUTRAL] Can you verify that patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, the patient's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Repeat the date of birth again.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] So let me give you the correct policy number.
[AGENT][NEUTRAL] Let me know when you're ready for it.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] It's 256-6549. That's 256-6549.
[AGENT][NEUTRAL] This policy has been active since [PII] and it's currently active.
[CUSTOMER][NEUTRAL] You are saying that uh this is the new policy number for this member, is that right?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] And the policy is active from [PII] with no term date.
[AGENT][NEUTRAL] No, that's correct. This policy is currently active in.
[CUSTOMER][NEUTRAL] Is that right?
[CUSTOMER][NEUTRAL] OK, currently active.
[CUSTOMER][NEUTRAL] OK. I do have a CPD code. I just want to verify that it requires authorization or not. Could you please help me with that?
[AGENT][NEUTRAL] No, this policy doesn't work that way. It's just the place of service. Do you have a place of service? Is it inpatient, outpatient, office visits?
[CUSTOMER][NEUTRAL] Yes, the place of services office.
[AGENT][NEUTRAL] So would it be an office visit CPT or a?
[AGENT][NEUTRAL] Procedure code CPT.
[CUSTOMER][NEUTRAL] It, uh, the procedure code is 70487.
[AGENT][NEUTRAL] What's your C
[AGENT][NEUTRAL] So that means this is the treatment received in the office. So the member's policy does not cover the the office visit itself, however, the treatment received in the office falls under the outpatient benefits of $3000 per calendar year. This is not a guarantee of benefits, just a disclaimer of the policy's coverage.
[CUSTOMER][NEUTRAL] You're saying that pre-certification is not required for the CBD code, is that right?
[AGENT][NEUTRAL] No, I did not say that. I stated that the policy does not cover office visits. However, it does cover the treatment received in the office, which falls under the outpatient benefits of $3000 per calendar year, and this is not a guarantee of benefits, just a disclaimer of the policy's coverage.
[CUSTOMER][NEUTRAL] Uh, the place of services office.
[AGENT][NEUTRAL] The office visit itself like 99214, that won't be covered, but the procedure that you provided will be covered under the outpatient benefits.
[AGENT][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hello, could you provide me with the spelling of your name? Is it, I got that and I just told you that office visits are not covered. However, the procedure code that you provided me with is covered, which falls under the outpatient benefits because the treatment received in the office is covered under the outpatient benefits. Could you provide me with the spelling of your name, please?
[CUSTOMER][NEUTRAL] Yes, uh, this is not an office visit procedure for.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, my name is [PII]. It's [PII].
[CUSTOMER][NEUTRAL] And you are saying that the procedure will cover and it uh no precertification is required for this CBT code, is that right? This is not an office visits procedure code. Yeah. And
[AGENT][POSITIVE] That is correct.
[AGENT][POSITIVE] Um, that's correct.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Your name, please?
[AGENT][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] [PII], and today's date as a reference.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Uh, insert your last name, please.
[AGENT][NEUTRAL] [PII]. Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, what was the time? You said that uh your name and today's date is uh
[AGENT][NEUTRAL] Reference number.
[CUSTOMER][NEUTRAL] Conference, and what was the time please?
[AGENT][NEUTRAL] Pardon me?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] What was the time, please?
[CUSTOMER][POSITIVE] OK yeah for sure.
[AGENT][NEUTRAL] You wanna know the time?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So let me look on my computer to verify the time. It's [PII]
[CUSTOMER][NEUTRAL] We already submitted
[CUSTOMER][NEUTRAL] Standard Time, is that right?
[AGENT][POSITIVE] Yeah, that's correct.
[AGENT][NEUTRAL] Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] Yeah, can I quickly summarize the call before, yeah, I just want to quickly recap the call before we end of the call. Can I?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, yeah, thank you. Today, I will call you to verify question requirements for a member, [PII]. And the date of birth is [PII] and the place of services office and the procedure code 70487. You said that precertification is not required for the CBD code and it will be covered and
[CUSTOMER][NEUTRAL] Your name is [PII]. It's [PII] and your last name is [PII]. The call reference number is your name, today's date and the time is [PII] Standard Time. Is that right, [PII]?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][POSITIVE] Yeah, thank you, [PII]. And uh this is the secondary insurance of the members. Uh, yeah, thank you, [PII]. Thank you for your assistance. Have a great day. Stay safe. Bye-bye.
[AGENT][POSITIVE] Thanks for calling APL. Have a great day. Goodbye.