AccountId: 011433970860
ContactId: db3d0fbe-462b-4b5f-8d82-9aee0970b5eb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 197979 ms
Total Talk Time (AGENT): 79461 ms
Total Talk Time (CUSTOMER): 62341 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/db3d0fbe-462b-4b5f-8d82-9aee0970b5eb_20250103T18:34_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], I'm calling to verify, uh, some insurance and to see if a patient needs prior authorization for a certain CPT code.
[AGENT][NEUTRAL] OK, I'm happy to double check uh eligibility. Do you have the patient's policy number?
[CUSTOMER][NEUTRAL] I do. It is 021-37675.
[AGENT][POSITIVE] Alright, thank you so much let me pull that up here.
[AGENT][NEUTRAL] And if I could get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alright, so the patient plan is active. The effective date is [PII]. This is their secondary insurance, so this covers deductible, co-pay, co-insurance that their primary does not. No pre-authorization is needed for the plan.
[CUSTOMER][NEUTRAL] OK, um, do you know if it is?
[CUSTOMER][NEGATIVE] We've got that you guys are out of network with us.
[CUSTOMER][NEUTRAL] Or not we don't have a contract with APL.
[CUSTOMER][NEUTRAL] Uh, would they still, do they have the patient have out of network benefits, do you know?
[AGENT][NEUTRAL] Yeah, I don't think that they have to use particular, let me see.
[CUSTOMER][NEUTRAL] Yeah, she has Cigna is her primary.
[AGENT][NEUTRAL] Are they
[AGENT][NEUTRAL] OK. Are they coming in for just like an office visit or?
[CUSTOMER][NEUTRAL] It is an echocardiogram.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Outpatient.
[AGENT][NEUTRAL] Yeah, so they could use this um network's not required, so yeah, they could definitely still use this and it looks like the outpatient benefit on this plan is a calendar day, so it looks like it's a benefit max of $500.
[CUSTOMER][NEUTRAL] OK, so they have all they have for this insurance is um a $1500.
[CUSTOMER][NEUTRAL] For the year.
[AGENT][NEUTRAL] No, ma'am. It's uh $500 per day.
[CUSTOMER][NEUTRAL] Per day, OK.
[CUSTOMER][NEUTRAL] OK, and that is, that's what I needed to know, sir, and what is the first initial of your last name and is there a call reference for this?
[AGENT][NEUTRAL] Mhm. Absolutely. So call references my name with my last initial and then today's date. My name again is [PII] spelled [PII] Last initial to my name is [PII].
[CUSTOMER][POSITIVE] Thank you so much, sir. Appreciate your time.
[AGENT][POSITIVE] You're welcome. Have a good one.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye-bye.