AccountId: 011433970860
ContactId: 4142f800-6e9a-471d-9d18-e83d18c007d8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 289869 ms
Total Talk Time (AGENT): 130166 ms
Total Talk Time (CUSTOMER): 82832 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/4142f800-6e9a-471d-9d18-e83d18c007d8_20250227T16:05_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling from doctor's office to check authorization requirement for some CPT codes.
[AGENT][NEUTRAL] OK, I can check to see if authorization is required. Um, I'm sorry, what did you say your name was?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. That is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah, I have.
[CUSTOMER][NEUTRAL] That is 948.
[CUSTOMER][NEUTRAL] 876.
[AGENT][NEUTRAL] OK, and then what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that [PII] Uh, so this policy is active. Effective date was [PII], and so this is a secondary medical policy and it is very dependent on major medical as long as major medical is willing to pay this policy can so no authorization is required.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] And uh but the member have primary SUC commercial.
[AGENT][NEUTRAL] I'm sorry, could you repeat that?
[CUSTOMER][NEUTRAL] Um, but the member primary policy was UHC commercial.
[AGENT][NEUTRAL] This is a secondary medical policy.
[CUSTOMER][NEUTRAL] OK. If the UHC pays, you will also pay, right?
[AGENT][NEUTRAL] Right, this plan is um very dependent on whoever they have as primary so if their primary does not pay this policy can't.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. Could you please verify the costs are covered by the member's plan?
[AGENT][NEUTRAL] I don't have a way to look up codes, Max. Um, are they gonna be receiving, excuse me, is it treatment received in office for outpatient?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, it's an outpatient service.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just a minute.
[AGENT][NEUTRAL] And of course I will let you know verification of coverage is not a guarantee of payment for claims, so their total outpatient benefit amount for this policy is $1250 per calendar year.
[AGENT][NEUTRAL] If you'll give me one moment, I'll see if any of that has been used.
[AGENT][NEUTRAL] OK, none has been used so far this year, so they do have that full benefit amount.
[CUSTOMER][NEUTRAL] Mm, sorry, what does that mean?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, what is it?
[AGENT][NEUTRAL] Their outpatient benefit amount is $1250 per calendar year. So this policy would pay up to that benefit amount.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] To receive benefits.
[AGENT][NEUTRAL] That's uh their benefit amount that's how much this policy would pay per calendar year for outpatient services.
[CUSTOMER][POSITIVE] OK, perfect, yes.
[CUSTOMER][NEUTRAL] OK. May I know the patients, how much um it's so far?
[AGENT][NEUTRAL] Um, yes, I did check that they have not used any so far this year, so they do have that full amount.
[CUSTOMER][NEUTRAL] OK. Um, until the patients reach the deductible amount, the insurance doesn't pay, right?
[AGENT][NEUTRAL] Um, no, that's how much the policy would pay. Is that $1250 up to that amount.
[CUSTOMER][NEUTRAL] He
[AGENT][NEUTRAL] This plan doesn't have any deductibles or anything like that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Thank you. And for my documentation, could you spell your name?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] And last name of your name, [PII]?
[AGENT][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] Was there anything else I could help you with, Max?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] May I know the reference number for our call?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial and today's date.
[CUSTOMER][POSITIVE] Thank you, [PII], for assisting me today. Have a great day. Take care. Bye.
[AGENT][POSITIVE] Of course, thanks for calling APL you too bye bye.