AccountId: 011433970860
ContactId: dbcb8b5c-9b9c-45ee-b446-ca354735b333
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 159660 ms
Total Talk Time (AGENT): 91095 ms
Total Talk Time (CUSTOMER): 50127 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/dbcb8b5c-9b9c-45ee-b446-ca354735b333_20250422T13:40_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], this is [PII] from um the provider's office. I'm just trying to check and see if some CPT codes need prior authorization for a member.
[AGENT][NEUTRAL] I'm sure, [PII] I can assist you with benefits. Um, first, I'll need a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] Uh, it's 02279408.
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] It's [PII]. It's [PII].
[AGENT][NEUTRAL] OK, thank you 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]. The policy is still active and um what codes?
[AGENT][NEUTRAL] Do you need me to look up?
[CUSTOMER][NEUTRAL] Um, he's having a screening colonoscopy.
[CUSTOMER][NEUTRAL] Um, my three codes, uh, 45378.
[CUSTOMER][NEUTRAL] Then 45,380, then 45385.
[AGENT][NEUTRAL] OK. Yes, ma'am. And I'm showing under these policies, as long as the screening codes are related to an illness or an injury and it's billed that way, then it would be covered under the policy, um, under that. This will be outpatient services, right? Or will it be admitted?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] It's outpatient.
[AGENT][NEUTRAL] OK, for outpatient, we cover up to 8100 per calendar year and that's for the co-pay, the co-insurance, and the deductible after the primary insurance processes a claim. And again, in order for it to be covered, it has to be related to an illness or an injury and a portion of it has to be covered by the primary insurance. If the primary insurance denies it, then yeah, we deny it also.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, so no prior authorizations required though with you guys.
[AGENT][POSITIVE] Right, that's correct.
[CUSTOMER][POSITIVE] OK awesome, can I have a a reference for the call?
[AGENT][NEUTRAL] Yes, for the reference number, you can use my name and today's date. My name is [PII], um it's spelled [PII] Last initial [PII] and today's date. Um, is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] No, that's it. Thank you so much. I appreciate your help.
[AGENT][POSITIVE] OK, thank you, [PII], for calling APL. Have a great day. Mm bye.
[CUSTOMER][NEUTRAL] You too bye.