AccountId: 011433970860
ContactId: dd11d385-c963-43a7-9522-c0eea2a7270a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 191539 ms
Total Talk Time (AGENT): 90529 ms
Total Talk Time (CUSTOMER): 52716 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/dd11d385-c963-43a7-9522-c0eea2a7270a_20250123T13:09_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling for eligibility and benefits please.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Is this for service in a doctor's office?
[CUSTOMER][NEUTRAL] It is.
[AGENT][NEUTRAL] OK, and what's the policy number?
[CUSTOMER][NEUTRAL] 01941542.
[AGENT][NEUTRAL] And I get phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] All right, thank you for that information, [PII], and we're checking eligibility and then office visit benefit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, CAT scan benefit.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] CAT scan. Is this gonna be done in an office setting or a diagnostic facility?
[CUSTOMER][NEUTRAL] Office settings.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And so I have that information for you. The effective date is [PII]. Uh this policy is active at this time.
[AGENT][NEUTRAL] And under this policy, um, there is not a treatment writer, so it in an office setting is not covered. It'll need to be done like in an outpatient facility or diagnostic facility.
[CUSTOMER][NEUTRAL] Alright, so this is where it gets kind of blurred. We are classified as place of service 11 in office. We are a free standing radiology facility, so would, would we fall under the benefit you just gave me not being, uh, covered?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm. Right.
[AGENT][NEUTRAL] Um, based on the place of service, but I understand your credentialed, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] To, um,
[AGENT][NEUTRAL] Perform that type service in an office type setting.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, generally because the policy does not have a treatment writer, which means if there's treatment performed, covered treatment performed in an office setting, it can be considered under the outpatient benefit. Uh, of course we can't verify, um, payment of, uh, of a claim, but I mean if you want to submit it for review, that's fine.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But based on the policy, I'm not seeing a treatment writer.
[CUSTOMER][NEUTRAL] Would it require prior authorization in any form office setting or free standing facility?
[AGENT][NEUTRAL] Yeah, prior off is not required.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] Any other questions?
[CUSTOMER][NEUTRAL] May I have, uh, yes, may I have a reference number for that information please?
[AGENT][NEUTRAL] Mhm you'll use my name in today's date, [PII].
[AGENT][NEUTRAL] Oh NYA.
[AGENT][NEUTRAL] First initial last name is [PII].
[CUSTOMER][POSITIVE] Great thank you so much you have a wonderful day.
[AGENT][POSITIVE] You're welcome, [PII]. Thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.