AccountId: 011433970860
ContactId: d752b3bc-15e4-4ef0-9257-30267273ab53
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 311209 ms
Total Talk Time (AGENT): 134539 ms
Total Talk Time (CUSTOMER): 148976 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/05/d752b3bc-15e4-4ef0-9257-30267273ab53_20250205T19:41_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling. I'm sorry, good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, I'm [PII] calling from facility to check the benefits and authorization for the CPT codes.
[AGENT][NEUTRAL] OK, I can verify benefits for you and you say your name is [PII]?
[CUSTOMER][NEUTRAL] Yes, my name is [PII].
[AGENT][NEUTRAL] OK, and what's the policy number you're inquiring about, please?
[CUSTOMER][NEUTRAL] The ID is 945137.
[AGENT][POSITIVE] OK, thank you so much. And do you have a callback number in case the call back uh in case the call drops?
[CUSTOMER][NEUTRAL] Yes. Yes. My callback number is [PII].
[AGENT][NEUTRAL] OK, and verify that patient's name, date of birth.
[CUSTOMER][NEUTRAL] The patient's name is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] OK, I'm showing his effective date is [PII]. Policy is active.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what benefits are you needing for this policy?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I do have CPD code. Could you please check the benefits for that and the authorization for that code?
[AGENT][NEUTRAL] Well, this policy has with our company is a secondary supplemental policy. I just need to verify if they are going to be inpatient or outpatient.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh this for outpatient hospital surgical goods.
[AGENT][NEUTRAL] OK. Well, not a guarantee of payment, just a verification of coverage. With this policy as secondary, we help with major medicals, deductible, co-pay, and or co-insurance, and the patient has a benefit max that pays up to $4000 per calendar year of what primary applies towards deductible, co-pay, or co-insurance.
[CUSTOMER][NEUTRAL] it's.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So the member has
[CUSTOMER][NEUTRAL] Uh, co-insurance of?
[AGENT][NEUTRAL] It's not a co-insurance. This is a secondary policy and as secondary, what we do is help with primary insurance deductible, co-pay and or co-insurance.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Up to their max benefit of $4000 per calendar year.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK. You're following the primary uh
[CUSTOMER][NEUTRAL] Primary payer, right?
[AGENT][NEUTRAL] We pick up what they apply towards deductible, co-pay, or co-insurance up to that benefit max.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK. The benefits is 4000 max.
[AGENT][NEUTRAL] Per calendar year, correct, for outpatient.
[CUSTOMER][NEUTRAL] For outpatient.
[AGENT][POSITIVE] Correct, yes ma'am.
[CUSTOMER][NEUTRAL] And this 4000 comes under uh deductible or out of pocket?
[AGENT][NEUTRAL] I'm sorry, say again.
[CUSTOMER][NEUTRAL] This 44,000 comes under a deductible or out of pocket?
[AGENT][NEUTRAL] That is the benefit max that he has for any outpatient services for the calendar year.
[CUSTOMER][NEUTRAL] OK. And uh the authorization requirements for the CPT codes?
[AGENT][NEUTRAL] Uh, prior authorization is not required with this policy.
[CUSTOMER][NEUTRAL] So you're following the Medicare, uh, payer guidelines, right?
[AGENT][NEUTRAL] No, it's just under this policy they have with our company, since it's a secondary supplemental plan, we don't require any prior authorization. You may have to check with their major medical.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] So this is a secondary uh supplement plan, so the authorization is not required for any courses.
[AGENT][NEUTRAL] Correct, we don't require any prior authorization, that is correct.
[CUSTOMER][NEUTRAL] And the $4000 is uh
[AGENT][NEUTRAL] But she, that's the benefit max that is payable for outpatient per calendar year.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So there is no co-pay, no coinsurance, no out of pocket, no deductible. Only 4000 benefit max calendar year.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Right? For any out of, out of
[CUSTOMER][NEUTRAL] Patient
[AGENT][NEUTRAL] For outpatient services.
[CUSTOMER][NEUTRAL] Outpatient.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] In an outpatient facility.
[CUSTOMER][NEUTRAL] OK. For outpatient services, it is uh 4000 max benefits is required. OK, thank you for the details. Could you please spell your name, please?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Your name is [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And the call reference KK?
[AGENT][NEUTRAL] Uh, we don't give call reference numbers. If you like, you may use my name at today state.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK. Thank you. Thank you for the details and have a wonderful day.
[AGENT][POSITIVE] Alright, you too. Thank you for calling APL Ms. [PII]. Bye.
[CUSTOMER][NEUTRAL] Bye bye.