AccountId: 011433970860
ContactId: 21291cba-5685-42bd-ba9a-d7cbba91bd28
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 456899 ms
Total Talk Time (AGENT): 149456 ms
Total Talk Time (CUSTOMER): 137156 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/21291cba-5685-42bd-ba9a-d7cbba91bd28_20250127T19:21_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes ma'am, I was calling to check eligibility and benefits for mental health outpatient and office professional visits.
[AGENT][NEUTRAL] OK, and
[CUSTOMER][NEUTRAL] And I have CPT codes also to check.
[AGENT][NEUTRAL] If you can just give me the chief complaint, that'll be fine.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] If you can just give me the chief complaint, that would be fine.
[AGENT][NEUTRAL] Can you hear me?
[CUSTOMER][NEUTRAL] Yes ma'am, hold on one sec.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEGATIVE] I'm not understanding what you're asking darling.
[AGENT][NEUTRAL] Instead of giving me the procedure codes, what's the description of the code? The chief complaint why they're being seen?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, give me a second, let me pull it up, mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that is it.
[CUSTOMER][NEUTRAL] F 31.9.
[AGENT][NEUTRAL] OK, what's a good, uh, your name and a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] and the phone number is [PII].
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] The first initial of your last name is [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And do you have a policy number for the patient?
[CUSTOMER][NEUTRAL] Uh, give me one second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] I have it right in front of me. It is policy number 02588076.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, so I'm showing an effective date of [PII].
[AGENT][NEUTRAL] So this policy is active at this time.
[AGENT][NEUTRAL] And let's see.
[CUSTOMER][NEUTRAL] OK, now I do have two codes that I need you to check to sit for uh telehealth and telephonic audio only.
[AGENT][NEUTRAL] Uh, virtual visits, but is that over the phone? It's a no, not over the phone.
[CUSTOMER][NEUTRAL] Yes ma'am, it's over the phone.
[AGENT][NEGATIVE] So over the phone is not covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEGATIVE] He l inability informed decisions.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So I do show an office visit benefit under the policy. It covers up to $50 per day.
[AGENT][NEUTRAL] With a maximum of 4 days per calendar year per covered person.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Any
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And of course the information provided is verification, not a guarantee of payment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And did you have any other questions, [PII]?
[CUSTOMER][NEUTRAL] OK, so, OK, say that again, the deductible?
[AGENT][NEUTRAL] Mm. The benefit is, is in office, so is this service in a doctor's office?
[CUSTOMER][NEUTRAL] Yes ma'am, it's life skills, it's a mental health facility.
[AGENT][NEUTRAL] So is it inpatient?
[CUSTOMER][NEUTRAL] Yes ma'am, inpatient.
[AGENT][NEUTRAL] And what's the name of the facility?
[CUSTOMER][NEUTRAL] Life skills.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so under this policy, it has to be um.
[CUSTOMER][NEUTRAL] Hollywood
[AGENT][NEUTRAL] As a result of a surgical procedure being done, otherwise it's not covered on an outpatient basis.
[CUSTOMER][NEUTRAL] OK, hold on for one second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] she needs you.
[CUSTOMER][NEUTRAL] You take this he said that nothing can after surgery.
[CUSTOMER][NEUTRAL] OK, so mental health services are not covered?
[AGENT][NEUTRAL] In an outpatient facility, no.
[CUSTOMER][NEUTRAL] OK, so no outpatient off office visits for mental health are not covered.
[AGENT][NEUTRAL] OK, she said it was in a facility. So a benefit in a, in an office.
[CUSTOMER][NEUTRAL] No, it's, it's an, it's, yeah.
[AGENT][NEUTRAL] OK, so I gave her the offer.
[CUSTOMER][NEUTRAL] Sorry she's she's new.
[AGENT][NEUTRAL] OK. So, I've provided the office visit in a physician's office, uh, which is up to $50 per, per day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] And the maximum number of days per calendar year per person is 4.
[CUSTOMER][NEUTRAL] In
[AGENT][NEUTRAL] So this is gonna be in a, in a specialist office?
[CUSTOMER][NEUTRAL] Yes it is.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So would she like would there be a co-pay amount that she pays or would it be the $50?
[AGENT][NEUTRAL] Yeah, the benefit her policy will pay up to $50 of the bill charge.
[CUSTOMER][NEUTRAL] OK, so what would she be responsible for each visit?
[AGENT][NEUTRAL] We do not determine patients responsibility. We'll just pay the benefit up to the policy benefit maximum which is 50 per day.
[CUSTOMER][NEUTRAL] Oh OK so.
[CUSTOMER][NEUTRAL] Plan pays $50 client responsible for after.
[AGENT][NEUTRAL] Which we do not determine patients responsibility.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, and what's your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] [PII], OK. Any other questions?
[CUSTOMER][NEGATIVE] Um, so, uh, telephone and audio only is not covered.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and can I get your name and a reference number?
[AGENT][NEUTRAL] You'll use my name in today's date as your reference. [PII] First initial of last name is [PII]. And what's the first initial of your last name, [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Any other questions?
[CUSTOMER][NEUTRAL] All right, now I believe that's it.
[AGENT][POSITIVE] Alrighty, thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye-bye.