AccountId: 011433970860
ContactId: 8ec33e32-179f-44fd-aea3-b776c828444a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 342179 ms
Total Talk Time (AGENT): 109408 ms
Total Talk Time (CUSTOMER): 56086 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/8ec33e32-179f-44fd-aea3-b776c828444a_20250320T15:39_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, I'm calling to see if the CPT code needs to be pre-authorized for a patient.
[AGENT][NEUTRAL] OK, um, what was your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Are you with the provider's office?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, do you have a good callback number just in case the call gets dropped?
[CUSTOMER][NEUTRAL] Yeah [PII].
[AGENT][NEUTRAL] And [PII], I can help you with looking up that CBT. Do you have the policy number for the patient?
[CUSTOMER][NEUTRAL] Yeah it's uh 01848859.
[AGENT][NEUTRAL] You have the patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII]'s date of birth is [PII].
[AGENT][NEUTRAL] And what was the um CPT code and description?
[CUSTOMER][NEUTRAL] 76885.
[AGENT][NEUTRAL] And what is that for?
[CUSTOMER][NEUTRAL] Uh, it's an ultrasound, uh, infant hip dynamic.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see what kind of diag diagnostic.
[AGENT][NEUTRAL] I have
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, this is not a guarantee of payment, just a basic outline of the policy.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Are you in a physician's office or would this be in an outpatient facility?
[CUSTOMER][NEUTRAL] It's an outpatient facility.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so they do have diagnostic testing and a hospital outpatient facility.
[AGENT][NEUTRAL] Um, that would be a 4th or 2000.
[AGENT][NEUTRAL] $1000
[AGENT][NEUTRAL] Um, annual or a calendar year maximum.
[AGENT][NEUTRAL] Do you wanna see if he's used any of that?
[CUSTOMER][NEUTRAL] Oh, is it a covered service?
[CUSTOMER][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] So it does cover diagnostic testing, which
[AGENT][NEUTRAL] Let me make sure I don't see any exclusions hold on.
[AGENT][NEUTRAL] Just one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Can I place you on a brief
[AGENT][NEUTRAL] Hold for one moment.
[CUSTOMER][NEUTRAL] Yeah sure.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hey, I just wanted to make sure I'm not overthinking this. It's, it's diagnostic testing which an ultrasound should fall under that, correct?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, yeah.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I just wanted to make sure. OK, thank you.
[AGENT][NEUTRAL] All right, bye.
[AGENT][NEUTRAL] OK, thank you for holding. Um, yes, um, as I said, it's not a guarantee of payment, just a basic outline of policy, and that is a covered benefit under this plan.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] OK, does it need an authorization or anything?
[AGENT][NEUTRAL] No, we do not require an authorization and just be sure when you do file the claim that you include the primary explanation of benefits along with it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, uh, do you have a reference number?
[AGENT][NEUTRAL] Um, it's just gonna be my first name, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Last initial [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And to
[AGENT][NEUTRAL] Today's date. And [PII], is there anything else that I can help you with today?
[CUSTOMER][POSITIVE] No, I think that's all I need thank you.
[AGENT][POSITIVE] OK, thank you for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too bye bye bye.
[AGENT][NEUTRAL] Bye.