AccountId: 011433970860
ContactId: 1639aa81-c3a3-4aa1-9931-5fc2b7d169bf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 498980 ms
Total Talk Time (AGENT): 251573 ms
Total Talk Time (CUSTOMER): 233883 ms
Interruptions: 5
Overall Sentiment: AGENT=1.1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/1639aa81-c3a3-4aa1-9931-5fc2b7d169bf_20250122T19:47_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] I'm so sorry. What did you say your first name was?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII], my name is [PII]. Um, I'm calling from the counseling and Mon Center in regards to, um, this insurance that was given to us. Um, and I'm trying to find out benefits like what kind of plan this is, um, like I'm not, I've never heard of it, so I'm not sure if our clinician can even accept it or not. I don't know. Um, so yeah, I'm just trying to get a little bit of advice. I'm sorry.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, no, you're perfectly fine. It, it, these kinds of policies can be very confusing, um, so I will get that pulled up and let you know what kind of policy it is and things like that. First, [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][POSITIVE] Thank you, thank you.
[CUSTOMER][NEUTRAL] It's [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. All right. And did you have a policy number?
[CUSTOMER][NEUTRAL] Welcome.
[CUSTOMER][NEUTRAL] Yes, it looks like her policy number is 02579238.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] All right. And then, uh, can you verify the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Yes. Her name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, perfect, thank you for verifying that. Alright, so this policy, it is active um effective date was [PII]. So this is a secondary medical policy. It is designed to help with uh co-pay, deductible and co-insurance only after major medical pays. So if major medical does not pay, this policy can't.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK, I could do.
[CUSTOMER][POSITIVE] OK. OK, cool.
[CUSTOMER][NEUTRAL] OK, so this is a secondary medical policy. Is it like a Medicaid or a commercial like?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Um,
[AGENT][POSITIVE] This is gonna be considered more supplemental I think um is gonna be the best way to describe it, yes.
[CUSTOMER][NEUTRAL] That's what we're trying to
[CUSTOMER][NEUTRAL] A supplemental, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, cause we're sitting here looking at it. I said, well, I'm gonna just give a call cause we don't know what it is and like if
[AGENT][NEUTRAL] Of course, oh yeah, it is a bit different, um, so you just file the claims directly to us, all we would really need is the um explanation of benefits from their primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it does cover like mental health, like, I don't know if there's specific.
[CUSTOMER][NEUTRAL] Things that they pay or would not pay.
[AGENT][NEUTRAL] Um, let me take a look.
[AGENT][NEUTRAL] Um, when you say mental health, do you mean, um, is it like a physician's office environment or specialist office?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yes, the office visit. It's an outpatient office visit is what they consider it as.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] OK, let me double check. Some of these offer office visits, some of them do not, uh, so let me verify that. Give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Alright, and of course I will let you know verification of coverage is not a guarantee of payment for claims. So they do have.
[AGENT][NEUTRAL] Treatment for, let's see.
[AGENT][NEUTRAL] Mental or emotional disorder. Does that sound right to you?
[CUSTOMER][NEUTRAL] Um, well, I'm, I'm gonna say yes because I, I, I don't wanna call it a disorder. It just sounds so terrible. But you know, like the mental health, um, yeah, anything that deals with the mental health, um.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] No, that's OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, I'm not sure if they consider it disorders or, you know what I mean like I'm, I'm thinking it still should fall under there if.
[AGENT][NEUTRAL] I see.
[AGENT][NEUTRAL] I think I would think so, yes, especially with just the word mental, I think that's such a broad term, but it's so yeah, I think a lot of things could be considered that. OK, so per the policy underneath outpatient uh benefits, it does state treatment of mental or emotional disorder performed in a hospital outpatient facility, outpatient psychiatric treatment facility, or a physician's office. So,
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Exactly.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So it does sound like she has the coverage benefits. OK. So I'm gonna let my supervisor know that I spoke with you. It's, it's a supplement, we're gonna call it a supplemental policy that will cover any deductibles, co-pay, or co-insurances that the primary insurance doesn't cover, and we just filed claims. Now, I do see that there is a um payer ID.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, and so the electronic claims with the EOB from the primary attached will go to 660801, and we have a billing address of the [PII] and then the [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] And we've got a fax number as well if you needed that.
[CUSTOMER][NEUTRAL] OK, cool. So I'm gonna.
[CUSTOMER][NEUTRAL] Oh, OK. You can fax claims as well.
[AGENT][POSITIVE] Oh yeah, absolutely. Did you want that fax number?
[CUSTOMER][POSITIVE] Oh, OK. Yeah, that'll be even, that'll be even better. My supervisor left the fax.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Nice, yeah, I do too, um, OK, so our fax number is [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Wait, [PII]
[CUSTOMER][NEUTRAL] [PII]. OK, so I have [PII].
[AGENT][NEUTRAL] Correct. And now, before we go any further, I did want to stress just uh the verbiage of this in the policy does specify treatment of the medical, um excuse me, mental or emotional disorder. Um, so that being said, the visit itself would not be covered.
[CUSTOMER][POSITIVE] Awesome.
[AGENT][NEUTRAL] Does that make sense? So treatment for it would be in that um environment, yeah, just so that you know that expectation is there. I don't want any surprises.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the treatment for it.
[CUSTOMER][NEUTRAL] OK, treatment of mental.
[CUSTOMER][NEUTRAL] Health
[CUSTOMER][NEUTRAL] So for the treatment, like if they were coming in for
[CUSTOMER][NEUTRAL] See, and I'm wondering if that.
[CUSTOMER][NEUTRAL] The treatment of mental health.
[AGENT][NEUTRAL] I think it really depends on how they're, you know, the specific procedure codes and such, um, so if something is just going to be considered an office visit, then that wouldn't be covered, but anything else that would not be considered that, right.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And see, I think that's what.
[CUSTOMER][NEUTRAL] OK, OK, so, OK.
[CUSTOMER][NEUTRAL] OK, so can you say that one more time? The treatment of mental
[AGENT][NEUTRAL] Oh yes, let me read that exact verbiage to you give me just a minute.
[CUSTOMER][NEUTRAL] Yeah, yeah, because I need that exact verbiage so they can understand. I think it depends on the code, OK.
[AGENT][NEUTRAL] Of course. Yes, OK.
[AGENT][NEUTRAL] So, treatment of a mental or emotional disorder performed in a hospital outpatient excuse me, hospital outpatient facility, outpatient psychiatric treatment facility, or a physician's office.
[CUSTOMER][NEUTRAL] OK. Treatment of
[CUSTOMER][NEGATIVE] See, I'm not even gonna use that.
[CUSTOMER][NEGATIVE] This is where I'm getting messed up. OK, so let me write this again because I think I'm all over the place. So you said.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I think in just in shorter terms because it does specify separately as well, treatment in a physician's office. So, but it does also specify not including the physician's office visit fee. So that is located directly underneath. So I think it's just safe to say any treatment received in the office would be covered, just not the visit.
[CUSTOMER][NEUTRAL] OK, treatment received in office.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] It's covered, just not the visit.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] It's Covered
[CUSTOMER][NEUTRAL] Not
[CUSTOMER][NEUTRAL] OK. I'm just trying to write a word for word so I can get this over there.
[AGENT][POSITIVE] Of course, yeah, absolutely.
[CUSTOMER][POSITIVE] OK. All right. I appreciate it so much, [PII]. You enjoy the rest of your day.
[AGENT][NEUTRAL] Yes, did you have any other questions for me?
[CUSTOMER][POSITIVE] No, that was it. Thank you so much.
[AGENT][POSITIVE] Alright, yeah, it was a pleasure, [PII]. I hope you have a great rest of your day too. Thank you. All right, bye bye.
[CUSTOMER][POSITIVE] Thank you. You too. Bye-bye.