AccountId: 011433970860
ContactId: a500c4d2-f5fe-4df5-8231-3ab86b93ce8c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 292920 ms
Total Talk Time (AGENT): 120911 ms
Total Talk Time (CUSTOMER): 67711 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/a500c4d2-f5fe-4df5-8231-3ab86b93ce8c_20250422T18:13_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from Imaging Healthcare Specialist. I have a patient. I'm calling to check eligibility and benefits on and if authorization is required.
[AGENT][NEUTRAL] OK, I'll just say you're needing eligibility benefits and to see if prior authorization is necessary. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes ma'am, I can help you with those things. And [PII], what is a good callback number for you please?
[CUSTOMER][NEUTRAL] Sure, callback number is [PII].
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] Sure, I have, let's see, let me get the ID number. Hold on one second.
[CUSTOMER][NEUTRAL] I have policy number 02595600.
[AGENT][NEUTRAL] OK, thank you. Give me a couple moments please to get the member's information pulled up.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] And the information that I do.
[AGENT][NEUTRAL] Provide for you today Audra will be a verification of benefits, your pay name and date of birth.
[CUSTOMER][NEUTRAL] Sure, first name is [PII], last name is [PII]. Date of birth [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so I do show that he is a subscriber on this plan.
[AGENT][NEUTRAL] And this policy does show as active with an effective date of [PII].
[AGENT][NEUTRAL] And there would be no prior authorization required with APO because this is not major medical insurance, it's a limited benefit plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Can I give you a procedure code and tell me if it's a covered benefit?
[AGENT][NEUTRAL] No, ma'am, do you need inpatient, outpatient or office information?
[CUSTOMER][NEUTRAL] It's it's outpatient.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's outpatient diagnostic medical.
[AGENT][NEUTRAL] And what is the
[AGENT][NEUTRAL] What
[AGENT][NEUTRAL] OK, let me pull up the benefits for diagnostic because again, this is a limit mhm. Go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] Sure, it's for a new.
[CUSTOMER][NEUTRAL] Go ahead. Go ahead.
[AGENT][NEUTRAL] Or nuclear what?
[CUSTOMER][NEUTRAL] No, go ahead.
[CUSTOMER][NEUTRAL] It's nuclear medicine gastric emptying study.
[AGENT][NEUTRAL] OK, that is not going to benefit in the policy, but I'm going to double check it for you. Just one moment, OK?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK. So, on this plan, um, that is not one of the covered.
[AGENT][NEUTRAL] Test on this policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Do you have a reference number for the call?
[AGENT][NEUTRAL] Nuclear gastric emptying.
[AGENT][NEUTRAL] Yes, and you would actually use my name along with today's date. And if you will end up submitting a claim anywayalter with APO once the claim has been processed by us, we do have a portal that you should be able to check claim status in.
[AGENT][NEUTRAL] And the website that you would go to is secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, I do have a question. If it's not a covered benefit, why would we submit a claim?
[AGENT][NEUTRAL] We receive claims all of the time. I'm just letting you know that if you do submit it.
[AGENT][NEUTRAL] We do have that portal.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] All right, well, you're very welcome. So is there anything else I can help you with today?
[CUSTOMER][POSITIVE] No, that's it. Thank you.
[AGENT][POSITIVE] OK. Yes, ma'am. Well, you're very welcome for calling AP. Hope you have a nice afternoon.
[CUSTOMER][NEUTRAL] You too bye