AccountId: 011433970860
ContactId: 80fdfdf6-e970-4223-9dcb-cf5b46c24c49
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 195240 ms
Total Talk Time (AGENT): 82255 ms
Total Talk Time (CUSTOMER): 60221 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/80fdfdf6-e970-4223-9dcb-cf5b46c24c49_20250210T21:08_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII], initial, my last name is [PII], calling on behalf of the facility. I have CPT codes whether it requires alteration or not. Could you please help me with that?
[AGENT][NEUTRAL] OK, did you say your name is [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. I can help you, [PII]. What's the policy number?
[CUSTOMER][NEUTRAL] Give me a moment. The policy number is 025.
[CUSTOMER][NEUTRAL] 66526.
[AGENT][NEUTRAL] And what's a good call back number in case we're disconnected?
[CUSTOMER][NEUTRAL] The callback number is [PII].
[AGENT][POSITIVE] Thank you for that information.
[AGENT][NEUTRAL] What's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you [PII]. Now are you calling on behalf of the the provider's office or are you the policy holder?
[CUSTOMER][NEUTRAL] On the behalf of facility.
[AGENT][NEUTRAL] Both of your
[AGENT][NEUTRAL] OK, both of your names are [PII]. I was just checking.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said that you were wanting to verify if certain procedure codes require pre-certification?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, pre-cert is not required under this policy.
[AGENT][NEUTRAL] Pre-certification is not yeah, pre-certification is not required.
[CUSTOMER][NEGATIVE] Reset is not
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Then
[CUSTOMER][NEUTRAL] Is there any predetermination or it is optional?
[AGENT][NEUTRAL] There's no predetermination. Uh, this policy is secondary to the major medical plan, so this policy basically will reimburse.
[AGENT][NEUTRAL] Amounts applied towards the major medical deductible co-insurance and copay, so we are following the major medical plan.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So no pre-certification is required?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Could you please check the CPT code whether it requires the pre-certification or not?
[AGENT][NEUTRAL] It does not. It doesn't matter what the code is. It doesn't require pre-cert.
[CUSTOMER][NEUTRAL] OK, sure.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And pre predetermination is also not optional, right?
[AGENT][NEUTRAL] Yeah, this not for this policy dental, yes, but it's not for this policy. You don't have to send us anything to verify if it's gonna be covered or not.
[AGENT][NEUTRAL] So predetermination, predetermination, pre-authorization, it's not required.
[CUSTOMER][POSITIVE] OK, sure. Thank you for that, [PII].
[CUSTOMER][NEUTRAL] OK. Thank you for that, [PII]. Could you please provide your last name initial?
[AGENT][NEUTRAL] [PII] and you'll use my name in today's date as reference for today's call. Did you have any other questions, [PII], I can assist with today?
[CUSTOMER][NEUTRAL] No, [PII]. That's for now.
[AGENT][POSITIVE] Alrighty well thank you for calling APL. Have a good day.
[CUSTOMER][POSITIVE] Thank you, [PII], for your assistance. Have a great day. Bye-bye.
[AGENT][NEUTRAL] You too bye bye.