AccountId: 011433970860
ContactId: 418f412d-a00a-4ca8-baa8-cffd02273f8c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 303079 ms
Total Talk Time (AGENT): 159830 ms
Total Talk Time (CUSTOMER): 204443 ms
Interruptions: 16
Overall Sentiment: AGENT=1.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/418f412d-a00a-4ca8-baa8-cffd02273f8c_20250103T13:32_UTC.wav
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[AGENT][POSITIVE] And thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I'm [PII] calling from facility to check the authorization for the CPT codes.
[AGENT][NEUTRAL] I'm sorry, what are you needing? How can I help you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] We are calling from facility to check the authorization for the procedure codes if authorization is required or not.
[AGENT][NEUTRAL] If you're wanting to find out if
[AGENT][NEUTRAL] OK, you're wanting to find out if prior authorization is required?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your name again?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] My name is [PII]. It is [PII].
[AGENT][NEUTRAL] Thank you. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] My callback number is [PII] with the extension [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] Yes, just a moment, please. The member ID is
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] 945137
[AGENT][POSITIVE] Thank you one moment.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And any information that I provide for you today will be a verification of benefits, [PII], and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] The patient's name is?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII]. And the date of birth is [PII].
[AGENT][NEUTRAL] Thank you. So she is the spouse on this supplemental policy?
[AGENT][NEUTRAL] And the supplemental policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] This is a supplemental policy to her primary insurance, so therefore, there is no prior authorization required with our company.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, so you're following primary.
[AGENT][NEUTRAL] We are not a major medical insurance. Yes, we are a supplemental.
[CUSTOMER][NEUTRAL] So you're following primary payer guidelines?
[AGENT][NEUTRAL] That is correct. If the primary insurance does not pay, this policy would not pay. This policy is designed to help with co-pays, deductibles, and co-insurance amounts of coverage services. Now, when the claim is filed with us, [PII], you, we will need to receive a copy of the primary insurance company's explanation of benefits also for review along with the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK. So the uh member is active and you're following primary Medicare guidelines. They will pay, oh sorry, uh primary payer guidelines and if they pay, you pay, or if they don't pay, then you don't pay, right?
[AGENT][NEUTRAL] It depends, OK, so we would not pay if they do not pay anything. And then depending upon the service of review and the benefits available under this plan, uh, we would review the claim.
[CUSTOMER][NEUTRAL] you know
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, thank you. And the member has out of network benefits, right?
[AGENT][NEGATIVE] Cannot guarantee payments.
[AGENT][NEUTRAL] Again,
[AGENT][NEUTRAL] This plan does not have a network and there is no prior authorization required.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. Thank you. Thank you for the details. Could you please spell your name, please?
[AGENT][NEUTRAL] [PII] and my name in today's date will be the call reference number and also our portal to check claim status once we have processed the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And also to have access to the explanation of benefits.
[CUSTOMER][POSITIVE] Uh, I do have benefits.
[AGENT][POSITIVE] I secured.
[AGENT][NEUTRAL] OK, and our website if you need an EOB once the claim has been processed, is secured. [PII].
[CUSTOMER][NEUTRAL] Uh mhm.
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][POSITIVE] OK, thank you for the details. Could you please spell your name once again, please?
[AGENT][NEUTRAL] [PII], first initial to last name is [PII].
[CUSTOMER][NEUTRAL] And last, [PII].
[CUSTOMER][NEUTRAL] And the, OK, and the call reference, please?
[AGENT][NEUTRAL] My name and today's date.
[CUSTOMER][NEUTRAL] [PII] S and this date [PII], right?
[AGENT][NEUTRAL] [PII] S.
[CUSTOMER][POSITIVE] OK. Thank you, [PII]. Thank you, [PII]. Thank you for the details.
[AGENT][NEUTRAL] And today's date.
[AGENT][POSITIVE] You're welcome. And is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, thank you and have a wonderful day.
[AGENT][POSITIVE] I hope you have a very nice day too, [PII]. Thank you again for calling APL.
[CUSTOMER][NEUTRAL] You too, bye-bye.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Yeah.