AccountId: 011433970860
ContactId: 1ce81e98-d52f-4d1f-a388-fe485759ea50
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 582929 ms
Total Talk Time (AGENT): 209938 ms
Total Talk Time (CUSTOMER): 301007 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/08/1ce81e98-d52f-4d1f-a388-fe485759ea50_20250508T13:48_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling [PII] speaking. May I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. I do apologize. I am calling from a provider's office, calling to see if you're able to assist me verify eligibility for a patient for mental health.
[AGENT][NEUTRAL] Uh, yes, ma'am. I can verify eligibility for you and your name is?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK, and Ms. [PII], what is that policy number, please?
[CUSTOMER][POSITIVE] Sure, allow me one second. I'm so sorry. I kinda got off it.
[AGENT][NEUTRAL] Oh, no, you're fine.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Oh my Jesus.
[AGENT][POSITIVE] It's one of those day well been one of those weeks for sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] For real. It's almost done.
[AGENT][POSITIVE] thank goodness.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Policy number is gonna be 01263258.
[AGENT][POSITIVE] OK, thank you so much. And Ms. [PII], do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] Thank you. And the patient's name, date of birth?
[CUSTOMER][NEUTRAL] It's [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK. I see. I'm showing her effective date is [PII] and she is active on the policy and you're wanting to uh mental health benefits or just checking eligibility for?
[CUSTOMER][NEUTRAL] Um, mental health benefits if that's OK.
[AGENT][NEUTRAL] OK, give me one moment please.
[AGENT][NEUTRAL] And I apologize my system is moving really slow this morning.
[CUSTOMER][POSITIVE] No, you're fine. Take your time.
[CUSTOMER][NEUTRAL] And then I also wanted to know like, I see, I don't really deal with American public life, so I'm not too familiar with it. Um, so I kind of wanted to know, were we in network with them? How would exactly go because this patient gave me two cars, which is the APL and the United, so I'm a little confused.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, yes, ma'am. Well, the policy they have with us is a secondary supplemental plan. So, uh, what we do is we help with primary insurance deductible, co-pay or co-insurance for coverage services.
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] 1.
[CUSTOMER][NEUTRAL] Oh OK, but you're a secondary insurance.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Right. OK. OK, OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] That's good to know. Uh, give me one second. Uh, I see.
[AGENT][NEUTRAL] And is this treatment, is it for an office visit or is it for?
[AGENT][NEUTRAL] Because I do show mental health is covered and I do have office visits under the plan, uh, not a guarantee of payment, just a verification of coverage for an office visit, the max payable is $25 per visit, and they have a total of 4 visits per person, $8 total for family.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Uh, allow me one second. I'm sorry. You went really fast there for me. I hold on a second. No, don't, it's OK. Secondary, um, you said it's a max of how much?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] I apologize
[AGENT][NEUTRAL] $25 per visit, a max of 4 visits per person, and $8 total for family.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so it's only 4 visits, um, in total that they're covering. OK, cool, and again that is just a copay that you guys are doing. So if she had a co-pay from her, um, United, then you guys will cover it, um, let's say for instance she had a copay of $25 you guys will cover 4 visits of those $25 after it's been sent to the um first.
[CUSTOMER][NEUTRAL] Insurance, she paid out of pocket and then you guys will be covering that. I'm guessing reimbursing her. Is that correct?
[AGENT][NEUTRAL] Well, um, not necessarily, not unless she submits a claim or benefits are not assigned on the claim when we receive it, but the way it typically works is like the claim is sent to the primary. If the primary apply that amount towards her deductible co-pay or co-insurance, that's what we pick up and pay.
[AGENT][NEUTRAL] And it's either to the provider if they submit the claim or if the insured submits the claim, then we'll pay whoever submits the claim, pretty much.
[CUSTOMER][NEUTRAL] Mm, I'm sorry, I got a little lost there. OK, so, um, I'll go ahead and submit it to the United once the, but again, the copay, you're saying that let's say for instance she only had, she has a $25 co-pay, let's just say per per visit as per United, right? So you're saying that don't charge her those $25 because you guys are gonna cover the 1st 4 visits, is that correct? That's like abbreviation of what you're saying?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Pretty much, yes, ma'am.
[CUSTOMER][NEUTRAL] Oh, OK, I see what you're saying now. Um, the next thing would be, what else would I need from her? And you said that that was active [PII], right?
[AGENT][NEUTRAL] Uh, yes, ma'am. Oh no, [PII] is her effective date.
[CUSTOMER][NEUTRAL] OK. Thank you. No a return date?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Uh, no, it just shows the policy is being active.
[CUSTOMER][NEUTRAL] OK. And she is the, the policyholder?
[AGENT][NEUTRAL] Uh, she is the dependent on the plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] she said [PII].
[CUSTOMER][NEUTRAL] Give me one second, let me see because I do see something here.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Oh well, I guess you can say the spouse on the plan.
[CUSTOMER][NEUTRAL] OK, spouse, that's, that's more like it. I was like, who's all done.
[AGENT][NEUTRAL] It was like independent is usually a child.
[CUSTOMER][NEUTRAL] And I was like, wait, um, OK, hold on, cause I know she got dependent as [PII]. So wait, the spouse is the one that I don't know who the name is, [PII]?
[AGENT][NEUTRAL] [PII], yes, ma'am. Uh, that's who we show as the policyholder.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][POSITIVE] And I'm sorry, I'm just putting in all the information. I do apologize.
[AGENT][NEUTRAL] Oh no, you're fine.
[CUSTOMER][POSITIVE] [PII] and thank you, [PII], right?
[AGENT][NEUTRAL] Uh, yes, ma'am.
[CUSTOMER][NEUTRAL] OK. Oh, he's a male. Um, can I have a date of birth for [PII]?
[AGENT][NEUTRAL] Uh, that we cannot give dates of birth. We can verify other information though.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Like
[CUSTOMER][NEUTRAL] That's fine. She could probably input that when it's time to fill out the form. I'm not worried too much about that. OK. And so you did say any co-payment for her?
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] Uh, deductible, co-pay, or co-insurance, uh, to that max benefit of $25 for an office visit.
[CUSTOMER][NEUTRAL] So that means that she does have a, a deductible that that applies?
[AGENT][NEUTRAL] No, ma'am, that means as secondary, we pick up what primary applies towards deductible, co-pay or co-insurance. So if she come in for the office visit and she, um, after primary process the claim and they apply $25 towards the copay, that's what we will pick up and pay up to that max benefit of 25.
[CUSTOMER][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] All right. So I'm just gonna put like 0 copay here and zero deductible because really you guys, I just needed to know like if um before you guys cover those $25 if you guys had your own deductible, but apparently it's not, it's not.
[AGENT][NEUTRAL] Uh, no, ma'am, she doesn't have any deductibles, uh, with our company.
[CUSTOMER][NEUTRAL] That's what you're saying to me.
[CUSTOMER][NEUTRAL] Thank you. The payer's ID is 60801.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] I appreciate that. And then is there a plan or group number?
[AGENT][NEUTRAL] Uh, group number is.
[AGENT][NEUTRAL] 17111.
[AGENT][NEUTRAL] Group name is Fisher Island Community Associates.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] I'm good.
[CUSTOMER][NEUTRAL] Eish.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Community, right? Associate. Thank you.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, and I think that's it for her. um, alright, I think that I'm all set. I have a better understanding on what the, the insurance itself, and you guys don't assist with because I am having a hard time getting her verified through United. You guys do not assist with that, of course, right?
[AGENT][NEUTRAL] Uh, no, ma'am.
[CUSTOMER][NEUTRAL] OK, may I have a reference number for this call and I'm good to go.
[AGENT][NEUTRAL] Uh, if you like, you can use my name in today's date.
[CUSTOMER][NEUTRAL] OK, can you provide me your name once again?
[AGENT][NEUTRAL] Yes ma'am, it's [PII] last initial [PII]
[CUSTOMER][POSITIVE] Thank you, [PII]. I appreciate you. You have a great afternoon.
[AGENT][POSITIVE] Oh, you're welcome. Oh, you too, and I thank you for calling APL, Ms. [PII]. You have a great day.
[CUSTOMER][NEUTRAL] You too. Bye now.
[AGENT][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Um