AccountId: 011433970860
ContactId: d347fe63-1bd3-4afe-89d4-55c3eca61901
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 263950 ms
Total Talk Time (AGENT): 122798 ms
Total Talk Time (CUSTOMER): 109324 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/d347fe63-1bd3-4afe-89d4-55c3eca61901_20250205T19:54_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I'm [PII] calling from facility to check the authorization for the CPT codes.
[AGENT][NEUTRAL] OK, I can see if authorization is required. Um, [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] the [PII] [PII].
[AGENT][NEUTRAL] Thank you and then do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, the member.
[CUSTOMER][NEUTRAL] Policy number is
[CUSTOMER][NEUTRAL] yeah
[CUSTOMER][NEUTRAL] 945137
[AGENT][NEUTRAL] So that was 945137?
[CUSTOMER][NEUTRAL] Just a moment. Yes, 945137.
[AGENT][NEUTRAL] OK, thank you. And then what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] The name is [PII] and the date of birth is
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. Uh, so this policy is active. Effective date was [PII], and this is a secondary medical policy. It is very dependent on major medical, so it is designed to help with co-pay, deductible and co-insurance only after major medical pays. Uh, so in that case no authorization is required as long as major medical is willing to uh pay this plan can.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. The, so member has out of network benefits?
[AGENT][NEUTRAL] This plan does not operate within a network, so again as long as their major medical is willing to pay this plan can if their major medical does not this plan can't.
[CUSTOMER][NEUTRAL] So they, uh they are following the primary guidelines?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK. So you're following the primary guidelines and no authorization is required. And uh there are any benefits like uh co-pay, co-insurance, out of pocket.
[AGENT][NEUTRAL] Oh, give me just a moment. This is for outpatient, correct?
[CUSTOMER][NEUTRAL] Yes, it is for outpatient.
[AGENT][NEUTRAL] OK, uh, so this plan does not have any deductibles, um, of course I will no verification of coverage is not a guarantee of payment for claims, uh, so no co-pay, no deductible. The total outpatient benefit is $4000 max per calendar year.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, and if you'll give me one moment, I'll see if any of that has been used.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, and this was for [PII] correct?
[CUSTOMER][NEUTRAL] Yes, so it, it is for [PII].
[AGENT][NEUTRAL] OK, so, so far as uh for [PII] [PII] has used $1,187.10.
[CUSTOMER][NEUTRAL] OK. For $4000 maximum benefits. And uh she has been used $1,187.10 right?
[AGENT][NEUTRAL] Maximum, yes.
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] And after this 4000, the patient is responsible for all the
[CUSTOMER][NEUTRAL] Payments, right?
[AGENT][NEUTRAL] We don't say we don't say what is patient responsibility that would be up to the provider, um, but once that $4000 has been exhausted, we will be unable to pay any additional outpatient benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. Thank you. Thank you for the details. Could you please spell your name, please?
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] Yes, it's [PII]. Did you have any other questions for me?
[CUSTOMER][NEUTRAL] Uh, it is [PII] and last name first name [PII].
[AGENT][NEUTRAL] Last initial is [PII].
[CUSTOMER][NEUTRAL] And the call reference for this?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date.
[CUSTOMER][NEUTRAL] OK, [PII]. So the, uh, so you're following the primary guidelines and no authorization is required for uh all the courses and you don't follow the networks, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK. Thank you, thank you for the details and have a wonderful day.
[AGENT][POSITIVE] You too thank you bye bye.
[CUSTOMER][NEUTRAL] Bye bye.