AccountId: 011433970860
ContactId: c156fb58-c716-418d-9f36-fa6908888b4c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 215699 ms
Total Talk Time (AGENT): 86578 ms
Total Talk Time (CUSTOMER): 83677 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/c156fb58-c716-418d-9f36-fa6908888b4c_20250319T16:14_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes ma'am, my name is [PII]. I'm calling from [PII]. Um, I was calling to see if I can get eligibility and benefits on a patient for a CPT code for hospital outpatient, and I would need to know, um, if preop is required, please.
[AGENT][POSITIVE] I'm sure [PII] can assist you with benefits. Um, first, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh-huh, it's [PII].
[AGENT][NEUTRAL] Thank you. Now, I need the policy.
[CUSTOMER][NEUTRAL] And what was your name again, ma'am?
[AGENT][NEUTRAL] My name is [PII]. Um, it's spelled [PII] and my last initial is [PII].
[CUSTOMER][POSITIVE] Thank.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm, no problem. And could I get the policy number, please?
[CUSTOMER][NEUTRAL] 02581185
[AGENT][NEUTRAL] OK, thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Um, [PII] [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 what's the place of service, um.
[AGENT][NEUTRAL] For, for the, for the procedure. Um, will it take place in an outpatient facility or?
[CUSTOMER][NEUTRAL] Um, it's
[CUSTOMER][NEUTRAL] It's outpatient hospital, mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And is it for surgery?
[CUSTOMER][NEUTRAL] Um, no, she's, it's for ultrasound.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, under this policy for outpatient um visits, including outpatient hospital visits, we cover up to 4 visits per calendar year and we cover up to $50 per visit.
[CUSTOMER][NEUTRAL] OK, so with the way um this policy works, um, is the patient they don't pay anything upfront, they just wait for their bill, is that how that works?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, um, and I have, do you all go by CPT codes just to see, um, if pre-authorized be required for this visit.
[AGENT][NEUTRAL] Yes, ma'am. What's the CPT code?
[CUSTOMER][NEUTRAL] Um, 93971.
[AGENT][NEUTRAL] And this is related to an illness or an injury, right?
[CUSTOMER][NEUTRAL] Um, no, ma'am, not to my knowledge, no.
[AGENT][NEUTRAL] OK. Do you know the diagnosis code?
[CUSTOMER][NEUTRAL] Uh-huh, um, I have it right here, um, is D as in David 17.20.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Yes, ma'am. I'm showing that this will be covered and there's no authorization required.
[CUSTOMER][POSITIVE] Alrighty thank you so much and may I get a reference number for our call, please?
[AGENT][NEUTRAL] Yes, for the reference number, you can use my name at today's date. Um, is there anything else that I can assist you with?
[CUSTOMER][POSITIVE] No, ma'am, that'll do it. Thank you so much.
[AGENT][POSITIVE] OK, thank you, [PII], for calling ATL. You have a great day. Mm bye.
[CUSTOMER][POSITIVE] You too thank you so much bye bye.