AccountId: 011433970860
ContactId: d6f8f4bc-6125-449d-ba3b-d4b831c11e43
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 281799 ms
Total Talk Time (AGENT): 79445 ms
Total Talk Time (CUSTOMER): 105285 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/d6f8f4bc-6125-449d-ba3b-d4b831c11e43_20250528T17:21_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hi, this is [PII], and I am calling from Botox one in a recorded line. I am calling at the request of the provider to obtain benefits for the physician administered medication, Botox.
[AGENT][NEUTRAL] And you said your name was [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] and [PII], if I can get a good call back number for you?
[CUSTOMER][NEUTRAL] It is [PII], option one.
[AGENT][POSITIVE] Thank you for that, [PII]. I'd be happy to assist with benefits and eligibility.
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] 01935517.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment. I do show the policy is currently active. Effective date is [PII].
[AGENT][NEUTRAL] Um, and is this, you said it's Botox. Is this a medically necessary or cosmetic?
[CUSTOMER][NEUTRAL] It's for medical.
[CUSTOMER][NEUTRAL] For spasmodic torticollis.
[AGENT][NEUTRAL] OK, and is this for inpatient or outpatient?
[CUSTOMER][NEUTRAL] Outpatient on the provider's office.
[AGENT][NEUTRAL] OK, I do show treatment and procedures in the office is covered under the outpatient benefit of $6000 per calendar year.
[CUSTOMER][NEUTRAL] OK, got it. So this plan is secondary and it will cover up to $6000 per calendar year.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, perfect. And is prior authorization required?
[AGENT][NEUTRAL] Um, no, we don't require prior authorization.
[CUSTOMER][NEUTRAL] OK, and that's because uh this plan is secondary, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, got it. And there is no deductible no out of pocket maximum?
[AGENT][NEUTRAL] No, those are questions for her major medical. We're her gap insurance.
[CUSTOMER][POSITIVE] OK, perfect. Got it. And about the plan, can I have the plan's name, group name, uh group number, please?
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][NEUTRAL] Sure thing.
[AGENT][NEUTRAL] OK, the group the group number is 23669.
[AGENT][NEUTRAL] And the group name is Grant Iron and Motors Incorporated.
[CUSTOMER][NEUTRAL] OK and uh does this plan runs on my calendar or benefit year?
[AGENT][NEUTRAL] Calendar
[CUSTOMER][NEUTRAL] Got it. Thank you. And can you confirm if the provider is the network?
[AGENT][NEUTRAL] I'm sorry, repeat that for me.
[CUSTOMER][NEUTRAL] Uh, can you confirm if this provider is in network with the patient's plan or that depends on the primary payer?
[AGENT][NEUTRAL] That's the primary um we don't have a network so we follow the guidelines of the primary.
[CUSTOMER][POSITIVE] OK, got it. Thank you very much. That will be all. And to reference my call, can I have the initial of your last name and the reference number, please?
[AGENT][NEUTRAL] Reference is just my name [PII], last initial [PII], and the date and time of the call. Was there anything else I could assist with today?
[CUSTOMER][POSITIVE] That will be all. Thank you very much and have a great day.
[AGENT][POSITIVE] Thank you for calling APL have a good day.
[CUSTOMER][POSITIVE] Thank you.