AccountId: 011433970860
ContactId: b1e46d26-7fb9-4a50-bb6b-f0ce7b7db2d3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 636669 ms
Total Talk Time (AGENT): 172404 ms
Total Talk Time (CUSTOMER): 206904 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/23/b1e46d26-7fb9-4a50-bb6b-f0ce7b7db2d3_20250523T17:04_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII]. I'm calling from the facility. How are you? How's your day going?
[AGENT][NEUTRAL] Good, you're calling from where?
[CUSTOMER][NEUTRAL] I'm calling from the servicing facility.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh I, I would like to verify whether uh the procedure code is required in or not for the member. So would you assist me on that to check?
[AGENT][NEUTRAL] Sure, I can help you with that. Um, can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And what's the policy number?
[CUSTOMER][NEUTRAL] The member's policy ID.
[CUSTOMER][NEUTRAL] 016
[CUSTOMER][NEUTRAL] 914
[CUSTOMER][NEUTRAL] 57
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima.
[CUSTOMER][NEUTRAL] 8
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And you're calling for claim status?
[CUSTOMER][NEUTRAL] Uh, no, uh, about the authorization requirement?
[AGENT][NEUTRAL] Oh, OK. Um, what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, patient name is uh
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] The date of birth is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Right. This policy has an effective date of [PII], and the policy lapsed on [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, could you please repeat one more time? So what is the effective date?
[AGENT][NEUTRAL] The effective date was [PII].
[AGENT][NEUTRAL] And it lapsed on [PII].
[CUSTOMER][NEUTRAL] So, you said [PII]?
[AGENT][NEUTRAL] Yes, and are you inquiring about?
[AGENT][NEUTRAL] A claim coming up? Is she going in for services?
[CUSTOMER][NEUTRAL] Uh, no. So you said this member plan, member's plan is currently not active, right? inactive?
[AGENT][NEUTRAL] She does have an active policy with us, but that one that you gave me is no is lapsed.
[CUSTOMER][NEUTRAL] OK. So this, this plan is currently uh termed, right?
[AGENT][NEUTRAL] Right, the policy you gave me is no longer active, but she does have an active policy with us. It has a different number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. She has different alternative uh policy, right?
[AGENT][NEUTRAL] Right, it's a different policy number.
[CUSTOMER][NEUTRAL] OK. Uh, so what is the, uh, term date of this plan you said? You said [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Of [PII]. Yes, sir.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, great.
[CUSTOMER][POSITIVE] OK. Thank you so much for that. And what is the updated policy ID of this member?
[AGENT][NEUTRAL] The new policy is 255.
[AGENT][NEUTRAL] 8033.
[CUSTOMER][NEUTRAL] 2558033, right? The updated uh current plan ID?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Uh, so what is the effective weight of this ID, the new ID?
[AGENT][NEUTRAL] The effective date is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So this members uh plan ID that I provided.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 01691457. M as in Mike, L as in Lima 8 is got termed and the effective rate is [PII] and uh termed on 10-122. And this number has the updated plan. Uh the policy ID is 2558033 and the effective rate of the new plan is 10-124, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK, great.
[CUSTOMER][POSITIVE] OK, thank you so much for that.
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Uh, may I get your name that's spelled?
[CUSTOMER][NEUTRAL] Uh, yes. So what about the, uh, you would like to verify an authorization requirement for the procedure code for this number?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm sorry, can you repeat that one more time?
[CUSTOMER][NEUTRAL] Uh yeah, sure. So I do have an uh
[CUSTOMER][NEUTRAL] Uh, procedure code to verify whether it requires an authorization or not.
[CUSTOMER][NEUTRAL] The CPT code requires an author or not for this number.
[AGENT][NEUTRAL] OK, what's the procedure code?
[CUSTOMER][NEUTRAL] Uh, sure. The procedure code is.
[CUSTOMER][NEUTRAL] 72146 uh
[CUSTOMER][NEUTRAL] Yes, I do have two quotes here. The first one is 72146.
[AGENT][NEUTRAL] And what is that for?
[CUSTOMER][NEUTRAL] Did you got
[CUSTOMER][NEUTRAL] Uh, that is for MRI spine.
[CUSTOMER][NEUTRAL] Thoracic without contrast.
[AGENT][NEUTRAL] OK, let me see if she has MRI's.
[AGENT][NEUTRAL] Covered
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And also you do have another one code as well?
[AGENT][NEUTRAL] What's the other code?
[CUSTOMER][NEUTRAL] The other code is 72148.
[CUSTOMER][NEUTRAL] It's for MRI spine lumbar without contrast.
[AGENT][NEUTRAL] I'm sorry, it's a what?
[CUSTOMER][NEUTRAL] Uh, it's for MRI spine lumbar.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So those two codes are 72146 and 72148.
[AGENT][NEUTRAL] Let me look at that, look that up real quick.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] And this is a verification of benefits and not a guarantee of payment.
[AGENT][NEUTRAL] So let me see if.
[AGENT][NEUTRAL] MRI is covered.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I am showing that MRI's are, they should be covered.
[AGENT][NEUTRAL] Um, again,
[AGENT][NEUTRAL] This is a secondary gap insurance policy, so we will need the primary.
[AGENT][NEUTRAL] Um, explanation of benefits when doing a uh claim for this one because we bill through, we help pay for co-insurance, co-payment, and deductible.
[CUSTOMER][NEUTRAL] OK, so you guys are not required an authorization, right? The primary authorization is enough?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK. So no need to submit a secondary code, uh, secondary author for this, right?
[AGENT][NEUTRAL] Right. Whenever you file the claim, we'll just need the major medical or the primary insurance's detailed um explanation of benefits that has those procedure codes on them.
[CUSTOMER][NEUTRAL] OK, sure.
[CUSTOMER][POSITIVE] Yeah, that's fine. OK, thank you so much for your assistance and uh may I get your name that's spell in the call reference number?
[AGENT][NEUTRAL] So my name is [PII].
[AGENT][NEUTRAL] [PII] until 8.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And then you can use today's date.
[CUSTOMER][NEUTRAL] Uh, could you please repeat your name one more time? You said, uh.
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And he is not children, right?
[AGENT][NEUTRAL] And I'm sorry, in today's date.
[CUSTOMER][NEUTRAL] And first is your last name is uh [PII]?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Yup. Thank you so much for your assistance and uh have a great day.
[AGENT][POSITIVE] Great, thank you so much for calling APL. Have a great day.
[CUSTOMER][POSITIVE] Yeah. You too. Bye-bye. Take care.
[AGENT][NEUTRAL] Right bye.