AccountId: 011433970860
ContactId: 0d94ff83-ab61-4e78-8c9d-bc150a7587cb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 417339 ms
Total Talk Time (AGENT): 132211 ms
Total Talk Time (CUSTOMER): 81561 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/0d94ff83-ab61-4e78-8c9d-bc150a7587cb_20250304T18:25_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Um, yes, ma'am. My name is [PII]. I'm calling with Lisans Health. I don't think I pressed the right button, but I needed to get benefits for a patient of ours.
[AGENT][NEUTRAL] May I have a callback number?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] May I have the policy number?
[CUSTOMER][NEUTRAL] Um, give me one second.
[CUSTOMER][NEUTRAL] Um, they said you wouldn't be able to pull it up with the, uh, member ID that starts with a D.
[AGENT][NEUTRAL] It should be one listed on that it starts with a 01 or 02 on the card.
[CUSTOMER][NEUTRAL] OK, let me see.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I don't see any other ID number.
[AGENT][NEUTRAL] May I have the member's first and last name please?
[CUSTOMER][NEUTRAL] Yes. First name is [PII].
[CUSTOMER][NEUTRAL] Last name is [PII].
[AGENT][NEUTRAL] Could you spell both for me?
[CUSTOMER][NEUTRAL] Yes, the first name is [PII]
[CUSTOMER][NEUTRAL] Last name is [PII]
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] May I have the date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And I did pull that member up. Would you like the member's number?
[CUSTOMER][NEUTRAL] Um, give me one second, let me get some little thing.
[CUSTOMER][NEUTRAL] OK, go ahead.
[AGENT][NEUTRAL] The policy number is 02.
[AGENT][NEUTRAL] 544663
[CUSTOMER][POSITIVE] Perfect. Thank you so much.
[AGENT][NEUTRAL] You're welcome, and you're calling in for benefits for this member?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Is there a specific benefit that you're needing to verify?
[CUSTOMER][NEUTRAL] Um, mental health.
[AGENT][NEUTRAL] Is this done within an outpatient or inpatient facility?
[CUSTOMER][NEUTRAL] Outpatient
[AGENT][NEUTRAL] I'm pulling that information up for you now.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So is this gonna be rendered within an office setting?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And verification of coverage does not guarantee the payment of the claim. This policy is an indemnity policy, which is a limited benefit. If there's anything that is left over, that is considered patient's responsibility. And for this member, they do have up to $50 per day, with the maximum of 4 days per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, so they don't have a copay or anything like that?
[AGENT][NEUTRAL] No, this is an indemnity policy, so it's just, it's a limited benefit, so that is the maximum amount that we will pay out on the claim.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK. And could you tell me where we need to fill the claims?
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] I'm pulling it up for you now.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You will submit claims to attention IMA.
[AGENT][NEUTRAL] And that mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] All right. And the pair ID?
[AGENT][NEUTRAL] The electronic payer ID is showing as.
[AGENT][NEUTRAL] 645-56.
[CUSTOMER][POSITIVE] Perfect. And if I could just get a reference number, I think that's all I need today.
[AGENT][POSITIVE] The reference number will be my first name, which is spelled [PII] last initial [PII] and today's date. And just in case I didn't give you a disclaimer with the benefits, verification of coverage does not guarantee the payment of the claim. And Casey, I do want to thank you so much for calling American Public Life. You have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you. You too.
[AGENT][POSITIVE] Thank you, bye.