AccountId: 011433970860
ContactId: 053fd221-f39a-4418-a46e-2da1b69893e4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 274029 ms
Total Talk Time (AGENT): 133991 ms
Total Talk Time (CUSTOMER): 78288 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/053fd221-f39a-4418-a46e-2da1b69893e4_20250218T15:15_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. This is [PII] calling from Nicholas Hospital.
[AGENT][NEUTRAL] I'm sorry, what was your name?
[CUSTOMER][NEUTRAL] Yeah, my name is [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] OK, [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Yeah, I just need to know about the patient, uh, [PII].
[CUSTOMER][NEUTRAL] Uh, the eligibility and benefit information uh regarding the benefits regarding mental health.
[AGENT][NEUTRAL] OK, you're needing eligibility and benefits for a member, is that correct, [PII]?
[CUSTOMER][POSITIVE] Yeah, yeah, that's right.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] Callback number is [PII] with extension of [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number?
[CUSTOMER][NEUTRAL] 02502559
[AGENT][POSITIVE] OK, thank you. Give me a moment sorry to get the member's information pulled up please.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And any information that I provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient's first name is [PII] and the last name is spelled as [PII] And the date of birth is [PII].
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so she is a dependent on the supplemental policies, Zara, and it is active with an effective date of [PII].
[AGENT][NEUTRAL] And you said this is for mental health. Is this for an office visit?
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Yeah, I just need about the benefit of mental health, um, outpatient uh specialist uh office visit in network benefits.
[AGENT][NEUTRAL] OK, so there is a network with this plan because this is a supplemental policy to her primary insurance company, and on this policy office visits are a covered service.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] She has an outpatient benefit maximum.
[AGENT][NEUTRAL] Per calendar year for covered outpatient services of $2500 with no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And because this is a supplemental policy to her primary insurance company, we will have to also receive a copy of her primary insurance company's explanation of benefits along with the claim for review.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then once we have processed our claim here at APLs are, you may check claim status and have access to our explanation of benefits by going to [PII].
[CUSTOMER][NEUTRAL] OK, thank you so much. And um um let me confirm it, uh, did this patient have any uh copy?
[AGENT][NEUTRAL] This is a supplemental policy to her primary insurance, that helps with co-pays, deductibles and co-insurance amounts of covered services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, thank you so much. That's confirmation I need for today. Um, may I get your name to be spelled and um also the call reference number?
[AGENT][NEUTRAL] My name again is [PII] and my name along with today's date would be your call reference number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you, [PII]. That's the information so far. Have a great day.
[AGENT][POSITIVE] You're very welcome. Yes, ma'am. You too. If that's all I can help you with, thank you again for calling APL and I do hope you have a great day also.