AccountId: 011433970860
ContactId: ecfbc94d-5cb6-40fe-8628-2552b6254635
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 509130 ms
Total Talk Time (AGENT): 185026 ms
Total Talk Time (CUSTOMER): 53375 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/ecfbc94d-5cb6-40fe-8628-2552b6254635_20250128T14:03_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, I was going to check on the status of a pre-authorization that we sent.
[AGENT][NEUTRAL] OK, may I have your name please?
[CUSTOMER][NEUTRAL] To bring that.
[AGENT][NEUTRAL] [PII], thank you, and your callback number if we are disconnected please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you, [PII]. And what is that policy number, please?
[CUSTOMER][NEUTRAL] 606-7887
[AGENT][NEUTRAL] OK, that was 606-7887. Thank you. And if you could also verify that patient's name and date of birth for me.
[CUSTOMER][NEUTRAL] Um, [PII], [PII].
[AGENT][NEUTRAL] OK, thank you very much for that verification process to bring that and you're calling to check on a pre-authorization or pre-start.
[AGENT][NEUTRAL] I'll pre estimate. I'm sorry, give me one second.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what procedures were submitted for for estimate?
[CUSTOMER][NEUTRAL] Um, D 6740 and D 2950.
[AGENT][NEUTRAL] 2950 and 6740. OK, thank you.
[AGENT][NEUTRAL] 67 1429 50. OK, thank you. One moment.
[CUSTOMER][POSITIVE] Good.
[AGENT][NEUTRAL] 2950. OK.
[AGENT][NEUTRAL] It shows that the estimate was received. Let me give me one second.
[AGENT][NEUTRAL] 6740.
[AGENT][NEUTRAL] And processed on [PII]. Give me one moment please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Just gonna take a look at that one you will be.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, so nothing came up. OK.
[AGENT][NEUTRAL] Uh, show that you'll be in our system. OK, give me one second. So for procedure codes 674-02950. Give me one moment.
[AGENT][NEUTRAL] And this plan that the member has, it pays on a fee schedule. Let me just check to see if those are covered benefits for the member. Bear with me. I'm so sorry, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, that's fine.
[AGENT][NEUTRAL] In regards to procedure code D 6740, I do not show that printed on the fee schedule, so I cannot state that that is a covered benefit for that procedure. Now for procedure code 2950, give me one moment to check that one for you.
[AGENT][NEUTRAL] OK, please note verification of benefits provided does not guaranteed payment for procedure code D2950. It shows a benefit of $45 and that's the benefit that we will pay on that procedure.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And again I'm not able to um give you a benefit amount for 6740 because I am not sure if there's a cover benefit because it is not printed on the fee schedule.
[CUSTOMER][NEUTRAL] OK, so, has, so the pre-op has been finalized or processed then?
[AGENT][NEGATIVE] It was processed on [PII]. I was going to try to fax over a copy of the EOB, but I'm not able to do that because it's not showing in our system.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let's see one thing other one moment.
[CUSTOMER][NEUTRAL] Cause I called on the [PII] and
[CUSTOMER][NEUTRAL] Whoever I spoke with said that it was still in review.
[AGENT][NEUTRAL] Yes, I showed that um there are notes showing that you called on the [PII], yes, and spoke to a representative.
[AGENT][NEUTRAL] Ok see fax sender.
[AGENT][NEUTRAL] May I place you on hold right now, please.
[CUSTOMER][NEUTRAL] Yes, that's fine.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] And thank you so much for your patience right now. I can check to see if the adjuster can reprocessed the pre-estimate, um, but in regards to that procedure code 6740, um, again, I cannot guarantee that it is a covered benefit because it's not printed on the fee schedule, which I can fax one over to you if you'd like as well.
[CUSTOMER][POSITIVE] Yes, yes, please.
[AGENT][NEUTRAL] OK, of course, and what is your fax number please right now?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and just let me repeat that to you just to confirm, I have that as [PII].
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][POSITIVE] OK, alright, I will get that faxed over to you and is there anything else I can assist you with please right now?
[CUSTOMER][NEUTRAL] Nope, that was all.
[AGENT][POSITIVE] OK, thank you so much for calling APL. You have a great day. Thank you.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][NEUTRAL] Yes, ma'am. Bye bye.