AccountId: 011433970860
ContactId: 5693b23c-fe15-497c-a59e-27853cdb6801
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 433250 ms
Total Talk Time (AGENT): 143645 ms
Total Talk Time (CUSTOMER): 110310 ms
Interruptions: 2
Overall Sentiment: AGENT=-0.2, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/5693b23c-fe15-497c-a59e-27853cdb6801_20250512T22:34_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] I am um calling from a physician's office and I'm calling to see if um a CPT code requires prior authorization.
[AGENT][NEUTRAL] OK, I can help you with prior authorization. May I please get your name and your call back number just in case our call is disconnected.
[CUSTOMER][NEUTRAL] Sure, my uh first name is [PII].
[CUSTOMER][NEUTRAL] Callback number is [PII].
[AGENT][NEUTRAL] Thank you, Ms. [PII]. And what is the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Uh, multi-care health system.
[AGENT][NEUTRAL] OK, and may I please get the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Um, her first name, I'm not sure how to pronounce, but it's spelled [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Last name is [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is um her date of birth, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] And her policy number.
[CUSTOMER][NEUTRAL] 025650007
[AGENT][NEUTRAL] OK, let me pull her up real quick for us.
[AGENT][NEUTRAL] OK, I do show that the member does have an active policy. The effective date is [PII].
[AGENT][NEUTRAL] And let me check something real quick.
[AGENT][NEUTRAL] Is this going to be inpatient or outpatient benefit?
[CUSTOMER][NEUTRAL] It'll be outpatient.
[AGENT][NEUTRAL] OK. And is it going to be in a physician's office or ER urgent care center, physical therapy center?
[CUSTOMER][NEUTRAL] Uh, physician.
[AGENT][NEUTRAL] Office
[CUSTOMER][NEUTRAL] Uh, physician's office.
[AGENT][NEUTRAL] OK, um, pre-authorization will not be required, uh, this is just to verify her benefits. It's not a guarantee of payment. She has a limited um hospital indemnity plan. She does have outpatient in a physician's office for accident or sickness treatment that pays $50.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And she gets 4 visits a year.
[CUSTOMER][NEUTRAL] OK. I'm sorry, you said.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] And you said um her outpatient benefits are for.
[AGENT][NEUTRAL] Accident or sickness treatment.
[CUSTOMER][NEUTRAL] You named a couple of things.
[CUSTOMER][NEUTRAL] Oh, exit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So I just wanna make sure I'm clear because I think.
[CUSTOMER][NEUTRAL] She's being referred to psychology.
[CUSTOMER][NEUTRAL] So she's being referred to a psychologist.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me look and see if she has mental health benefits and policy certificate and see if there's any mental benefits on.
[AGENT][NEUTRAL] Why follow the physician's office visit.
[AGENT][NEUTRAL] For accident
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Just give me just a moment while the computer pulls it in for us.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEGATIVE] It's trying to load.
[CUSTOMER][NEUTRAL] OK, sure.
[AGENT][NEUTRAL] Come on
[AGENT][POSITIVE] Decided to go slow. I'm so sorry.
[CUSTOMER][POSITIVE] OK, no worries.
[AGENT][NEGATIVE] So I don't see mental health. I see that it's gonna fall under the physician's office visit for accident or sick.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Are you there?
[CUSTOMER][NEUTRAL] And um,
[AGENT][NEGATIVE] Oh, OK. Oh, you scared me. I thought the phone hung up for a second. Yes, I can.
[CUSTOMER][NEUTRAL] Yeah, can you hear me?
[CUSTOMER][POSITIVE] OK, good. Um,
[AGENT][NEUTRAL] And if it does, I will call you back.
[CUSTOMER][NEUTRAL] OK. I, I think we're almost done, um.
[CUSTOMER][NEUTRAL] I just need a reference number or or something to refer back to this call.
[AGENT][NEUTRAL] Yes, ma'am. You can use my name [PII], and today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right, thank you, [PII], you've been very helpful.
[AGENT][POSITIVE] Well, you're very welcome, Ms. [PII], and I hope you have a wonderful night. We thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Bye bye, ma'am.
[CUSTOMER][POSITIVE] Thank you. Goodbye.