AccountId: 011433970860
ContactId: 87965636-8af7-467b-886c-da9685d23b3a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 505470 ms
Total Talk Time (AGENT): 143054 ms
Total Talk Time (CUSTOMER): 76183 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=-1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/87965636-8af7-467b-886c-da9685d23b3a_20250401T14:37_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, what did you say your name was?
[AGENT][NEUTRAL] Um, it's [PII]. Um, it's spelled [PII] and my last initial is [PII].
[CUSTOMER][NEUTRAL] OK, hi [PII], my name's [PII]. I am calling from uh Mercer County Community Hospital. I am calling about prior authorization for a CPT code for a patient.
[AGENT][POSITIVE] I'm sure [PII] I can assist you with um benefits. Um, first, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. Thank you. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] It is 02606638.
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] First name is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And his date of birth is.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. And just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII] and the policy is still active. And which benefit um do you need to verify or need a, um, you said a prior authorization code for?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] The CPT code is 74177.
[AGENT][NEUTRAL] And where will it take place? Will it take place in a doctor's office or outpatient facility?
[CUSTOMER][NEUTRAL] Outpatient facility.
[AGENT][NEUTRAL] Um, what at the MRI center or outpatient hospital?
[CUSTOMER][NEUTRAL] Outpatient hospital.
[AGENT][NEUTRAL] OK, one moment please because I'm not sure if um.
[AGENT][NEUTRAL] Authorizations are required under this policy. I'm gonna place you on a brief hold one moment.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][POSITIVE] Mhm. Thank you.
[AGENT][NEUTRAL] And is this also related to an illness or an injury?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] It's really, um, he's um like a heavy alcoholic.
[CUSTOMER][NEUTRAL] And abdominal swelling from that, so.
[AGENT][NEUTRAL] OK. All right. Let me place you on a brief hold. Let's see if this is covered under the policy. One moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, [PII], thanks for your patience. Um, I'm showing that under this policy for diagnostic testing done in outpatient facilities, we cover up to $100 per day, and he gets a maximum of 1 per calendar year.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And there is no authorization required, um.
[AGENT][NEUTRAL] And also for services provided, I'm showing um that are related to intoxication, um.
[AGENT][NEUTRAL] Drugs or alcoholism. I'm showing that there is no coverage, but of course, um we can deny or guarantee payment over the phone. We would have to see the claim first and go by whatever diagnosis code that's on the claim.
[AGENT][NEUTRAL] But again, for services provided in outpatient facilities for diagnostic testing, um, this policy covers up to $100 per day, and he gets one per calendar year and there's no authorization um required.
[CUSTOMER][NEUTRAL] So no prior authorization for the [PII].
[AGENT][POSITIVE] That's correct. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] All right, do you have uh um reference number or anything?
[AGENT][NEUTRAL] Um, yes, for the reference number, you can use my name and today's date. And again, my name is [PII], um spelled [PII] Last initial [PII], and today's date. Is there anything else that I can assist you with?
[CUSTOMER][POSITIVE] That is all I needed. Thank you.
[AGENT][POSITIVE] Mhm. I thank you again, [PII], for calling APL. Have a great rest of your day. Mm bye.
[CUSTOMER][POSITIVE] Uh huh thank you bye.
[AGENT][POSITIVE] Mhm. You're welcome.