AccountId: 011433970860
ContactId: 80cec7b2-d141-49cc-afa3-6702353f4c05
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 629989 ms
Total Talk Time (AGENT): 211350 ms
Total Talk Time (CUSTOMER): 77020 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/06/80cec7b2-d141-49cc-afa3-6702353f4c05_20250506T13:13_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII] and I'm calling with UT Health Austin. I was calling regarding a patient's um benefits and, uh, to find out if there's any pre-certification requirements.
[AGENT][NEUTRAL] OK, [PII], do you need eligibility as well or just to verify benefits and whether prior authorization is required?
[CUSTOMER][NEUTRAL] Yes, just that, just to find out if um prior authorization is required based on the benefits.
[AGENT][POSITIVE] Yes, I can help you with that. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and the member's policy number, please?
[CUSTOMER][NEUTRAL] Is
[CUSTOMER][NEUTRAL] 2558267
[AGENT][NEUTRAL] OK, thank you one moment while I get the member's information pulled up please.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And what is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] That is [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK, thank you. And any information that is provided would be a verification of benefits and not a guarantee of payment. So just one moment.
[AGENT][NEUTRAL] OK. And this, uh, so, um, the policy number that you provided me is a cancer policy. Is that what you were looking for?
[CUSTOMER][NEUTRAL] I'm not completely sure so I guess I'm just wanting that information as to what is covered under it.
[AGENT][NEUTRAL] OK. Again, this is a cancer policy, so what type of benefit information would you be needing? Inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Um, this patient is
[CUSTOMER][NEUTRAL] Um, this is an office and it's for a CT scan.
[AGENT][NEUTRAL] OK. And is it related to cancer?
[CUSTOMER][NEUTRAL] It is.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] I'm gonna have to pull, let me pull the benefits up on this.
[AGENT][NEUTRAL] Now, there would definitely not be any prior authorization required.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] But I don't know if, let me.
[CUSTOMER][NEUTRAL] Oh OK good to know.
[AGENT][NEUTRAL] OK. And you said this is for an office visit, is that correct?
[CUSTOMER][NEUTRAL] Well, we, we do the CT scans in an office setting.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] OK. So, uh, let me double check one more time that I'm not seeing benefits for that. So give me just a moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] But you said that she has already been diagnosed with cancer. Is that correct, [PII]?
[CUSTOMER][POSITIVE] That is correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. So she has a medical imaging benefits on here. Now, we will have to receive the pathology report and then because we
[AGENT][NEUTRAL] Confirming the cancer.
[AGENT][NEUTRAL] But there is a medical imaging benefit on this policy, once if it's has a positive diagnosis of cancer.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] And that benefit, mm, I've lost it again. I'm so sorry. These, these are just, let me.
[CUSTOMER][NEUTRAL] It's OK.
[AGENT][NEUTRAL] And that maximum.
[AGENT][NEUTRAL] It's for that would be with a positive diagnosis of cancer. It's per test. This benefit is per test, and it's a maximum of 1 test per cover person per calendar year following the diagnosis of cancer, that benefit amount is $500.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So again, we would have to receive, you know, obviously the claim, her primary EOB and pathology that confirms the diagnosis of cancer.
[AGENT][NEUTRAL] Has this been a recent diagnosis, [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, I'm not sure I'd have to go into the chart to look.
[AGENT][POSITIVE] Oh, OK. OK. No worries.
[AGENT][NEUTRAL] And again, I can't guarantee payment, we will just have to receive the information for review.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Alright, well that is all I'm needing um mhm.
[AGENT][NEUTRAL] And you do
[AGENT][NEUTRAL] OK. Oh, no, I'm sorry. I was just gonna ask you if there was anything else that I could help you with?
[CUSTOMER][NEUTRAL] Uh, no, that's gonna be all. Um, may I have a reference number for our call?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yeah, [PII], you would actually use my name along with today's date.
[AGENT][NEUTRAL] And then, I'm not sure if I already told you this or not because I was looking at that policy so in depth, but um if you all end up filing a claim with us,
[AGENT][NEUTRAL] Then you would, um, once we've processed the claim we do have a portal in which you should be able to check claim status in and that website is located at [PII].
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] And can I get your name again?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes ma'am, and you would use my name along with today's date is your call reference number, [PII].
[CUSTOMER][POSITIVE] Well thank you for your help today [PII].
[AGENT][POSITIVE] Well, you are certainly welcome and again, if that is all I can help you with, thank you for calling APL and I hope you have a very nice day.
[CUSTOMER][NEUTRAL] You as well.
[AGENT][POSITIVE] Yes, ma'am. Thank you so much.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Bye-bye.