AccountId: 011433970860
ContactId: 29f733a9-bdd4-42db-9fcf-21df349315ac
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 2083628 ms
Total Talk Time (AGENT): 605278 ms
Total Talk Time (CUSTOMER): 485732 ms
Interruptions: 3
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/29f733a9-bdd4-42db-9fcf-21df349315ac_20250107T15:23_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling to check, um, I have an appointment with the, um,
[CUSTOMER][NEUTRAL] A psychiatric facility today, uh, uh.
[CUSTOMER][NEUTRAL] Counselor, and they told me that they called and talked to y'all and y'all were listed as my primary insurance and when actually Blue Cross is my primary.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, OK, um, let me take a look at your policy and and look at the notes and see what was what happened. Um, [PII], may I have a good contact number in case we're disconnected and then your policy number?
[CUSTOMER][NEUTRAL] OK, it's
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you, and then your policy number whenever you're ready.
[CUSTOMER][NEUTRAL] OK, I see.
[CUSTOMER][NEUTRAL] It is
[CUSTOMER][NEUTRAL] 01.
[CUSTOMER][NEUTRAL] 63.
[CUSTOMER][NEUTRAL] 31
[CUSTOMER][NEUTRAL] 80.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] So I'm just waiting for the policy to come up here.
[CUSTOMER][NEUTRAL] And it's listed under my husband's name.
[AGENT][NEUTRAL] OK, here we go. And I just need you to verify your date of birth and then the mailing address on file.
[CUSTOMER][NEUTRAL] My date of birth is [PII].
[CUSTOMER][NEUTRAL] And the address is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. Well, thank you so much for verifying your information and all the information provided is a verification of benefits, not a guarantee of payment. Um, hold on one moment, I'm just going through your notes to try to see, but for
[CUSTOMER][NEUTRAL] It's Lake Area Psychiatry.
[AGENT][NEUTRAL] This policy would
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's where I'm going.
[CUSTOMER][NEUTRAL] That called you
[AGENT][NEUTRAL] Is Blue Cross Blue Shield through your employer or your husband's?
[CUSTOMER][NEUTRAL] My husband's employer, I'm not employed.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So, just from the notes.
[AGENT][NEUTRAL] I don't know where they called.
[AGENT][NEGATIVE] We don't have anything.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] She said she called this morning, I think.
[AGENT][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] But she also called, well, she checked with Blue Cross on the, my records with Blue Cross and Blue Cross has you listed as my secondary.
[CUSTOMER][NEUTRAL] But she said that she called and that y'all were my primary and that if they didn't bill you first.
[CUSTOMER][NEGATIVE] Before Blue Cross then that they wouldn't, I wouldn't pay.
[AGENT][NEUTRAL] No, that's not it at all. Um, OK, let me
[CUSTOMER][NEUTRAL] OK. That's what, this is what she said to me. That's why I'm calling. She said I should call.
[AGENT][NEUTRAL] Yes, um, let me do this. Let me place you on a brief hold. I, I had to keep keep clicking, but I do see some notes on here from today. Let me see, and if I need to call, um, because they have a callback number here, so I can call and rectify it for you. I just want to make sure I'm not, I'm not thinking wrong, but I'm this is not, yeah, it sounds like that was wrong, but let me just double check.
[CUSTOMER][POSITIVE] OK, that'd be great.
[AGENT][NEUTRAL] And then I can give them a call.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, that'd be great.
[AGENT][NEUTRAL] I just want to make sure I'm right before I call him and something else.
[CUSTOMER][POSITIVE] Right, that's why, that's why I wanted to call you too because I wanted, she asked me to just make sure that I should do it.
[AGENT][NEUTRAL] OK, hold on one moment for me, OK?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Who is [PII]?
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Let me see if [PII] is on a call.
[AGENT][NEUTRAL] Dang she's on a call.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, Ms. [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that long wait. I just wanted to check back with you. I'm reaching out to the, well, I'm speaking with my team lead, but we're reaching out to the claims, um.
[AGENT][NEGATIVE] I don't know what to call a claims representative that spoke to the to the provider to see.
[AGENT][NEUTRAL] Where she got that from because she is a claims adjuster, but just technically speaking, no, Blue Cross Blue Shield is major, so we have to build or the provider has to build the major whatever is major first and then like the secondary, I guess you can call it policies, but I'm I'm waiting for, yes, you're right. I'm waiting for my team lead and the claims rep. I just want to check that with you. I didn't want you to think I forgot about you or anything. I'm just working on the back.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's what I told her, but.
[CUSTOMER][NEGATIVE] Oh no, no, no, not at all.
[AGENT][NEUTRAL] OK, uh, so it will be just a few more moments, OK?
[CUSTOMER][NEUTRAL] OK, that's fine.
[AGENT][POSITIVE] All right, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, so thanks again for holding, Miss [PII]. So yes, um, the incorrect, it sounds like the incorrect information was given. Um, I have a callback number here from when uh [PII] called from the provider's office. Do you want me to call her on three-way and just let her know?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, yeah, that's fine if you wanna do that that way, that's fine.
[AGENT][NEUTRAL] OK, I just want it to be handled for you.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Alright, so hold on one moment. I'm gonna call them on the other line and then connect us all, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, that sounds great.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Thank you for calling Lake Area Psychiatry. Our new address is [PII]. Your call is very important to us. Our office hours are Monday through Thursday, [PII] and Friday [PII].
[CUSTOMER][NEUTRAL] If you have breached our voicemail system during normal business hours, we are either on the phone or assisting other patients.
[CUSTOMER][NEUTRAL] Please listen carefully as our menu options have changed. For general questions or to make a payment, press 1. For medication questions and prescription refill requests, press 2. For insurance and billing, press 3. If
[CUSTOMER][NEUTRAL] You have reached the billing department. Please leave your name, date of birth.
[AGENT][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] We're sorry you have reached a number that has been disconnected or is no longer in service. If you feel you've reached this recording and error, please check.
[CUSTOMER][NEUTRAL] Thank you for calling Lake Area Psychiatry. Our new address is [PII]. Your call is very important to us. Our office hours are Monday through Thursday, [PII] and Friday [PII].
[CUSTOMER][NEUTRAL] If you have breached our voicemail system during normal business hours, we are either on the phone or assisting other patients. Please listen carefully as our menu options have changed. For general questions or to make a payment, press 1. For medication questions and prescription refill requests, press 2.
[CUSTOMER][NEUTRAL] Your call is being transferred.
[AGENT][NEUTRAL] Hello, Ms. [PII].
[CUSTOMER][NEUTRAL] Lake Area psychiatry.
[AGENT][NEUTRAL] Hi, my name is [PII]. I'm hello?
[CUSTOMER][NEUTRAL] Hello. Yes.
[AGENT][NEUTRAL] My name is [PII]. I'm calling from American Public Life. I'm trying to reach someone named [PII]. Um, she gave us a call earlier about benefits and was given some incorrect information. Um, so I'm just trying to reach her to correct it so the patient can be seen.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect. What's the patient's name, ma'am?
[AGENT][NEUTRAL] Um, [PII].
[CUSTOMER][NEUTRAL] [PII] got it. OK, just one moment please.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Hi, this is [PII].
[AGENT][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from American Public Life. How are you?
[CUSTOMER][POSITIVE] I'm good. How are you?
[AGENT][POSITIVE] I'm doing good. I was just giving you a call back, um, because one of our mutual patients, um, [PII],
[AGENT][NEUTRAL] [PII], I'm sorry if I said that wrong. Yes, um, she called letting us know that you were told, uh, with her policy that the hospital indemnity policy should be should be major or billed first.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes, it was her primary, uh y'all were her primary insurance.
[AGENT][NEUTRAL] Yeah, I just wanted to um let you know the insured also has Blue Cross Blue Shield, so no, the the hospital indemnity policy would be second to that because that's a major insurance.
[CUSTOMER][NEUTRAL] OK, OK, so, um,
[CUSTOMER][NEUTRAL] Is
[CUSTOMER][NEUTRAL] Its secondary.
[AGENT][NEGATIVE] Because I think it, yeah, if you were to bill us first and then try to bill Blue Cross, then they're gonna mention coordination of benefits and give you a hard time with that because it's gonna show another insurance paid.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, yeah, I was because Blue Cross Blue Shield has y'all as
[CUSTOMER][NEUTRAL] The I had says that y'all are her secondary and then when I and then when I talked to [PII], she said something different and then when I talked to Miss [PII], she was like, no, they're definitely our secondary.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right. So yeah, I definitely apologize that that information was given. Um, Blue Cross has, has to be billed first or it's gonna be a a little mess.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Oh yeah, absolutely, um, well, OK, I have a que actually while I have you on the phone, I do have another question.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, so is that changed the benefits at all? So she has a $40 co-pay with Blue Cross Blue Shield, and then Evi had told me that y'all cover up to $100 per visit and she has 4 visits per year per calendar year.
[AGENT][NEUTRAL] I'm actually pulling up her um benefits, the full thing now, so I can see, but yes, I do see the 4 visits per calendar year. Let me, I just want to double check on the amount.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, hold on one moment.
[AGENT][NEUTRAL] And since we're going over benefits, I just want to say on the call, all the information provided is a verification of benefits, not a guarantee of payment, but let me see, 100.
[AGENT][NEUTRAL] Y'all are considered outpatient?
[CUSTOMER][NEUTRAL] Uh, yeah, mental mental health outpatient office visit.
[CUSTOMER][NEUTRAL] We usually do, uh, we whenever we send a claim it's sent.
[AGENT][NEUTRAL] Let me look at this. Hold on one moment, OK?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] What in the world did y'all do, claims?
[AGENT][NEGATIVE] Here goes keten fixing the mess. Oh my [PII], she doesn't even have.
[AGENT][NEUTRAL] What is she reading?
[AGENT][NEUTRAL] Uh uh.
[AGENT][NEGATIVE] I'm not getting in this.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] She doesn't have.
[AGENT][NEUTRAL] What did she call her?
[AGENT][NEUTRAL] 4 visits per year at $100. What?
[AGENT][NEGATIVE] Oh no, [PII] is gonna have to listen to that call. What in the world, [PII], I don't know, [PII], she gonna be mad.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Let me just double check and make sure outpatient sickness writer.
[AGENT][NEGATIVE] This is a hospital indemnity policy. They don't even have.
[AGENT][NEUTRAL] Oh my [PII].
[AGENT][NEUTRAL] Alright, [PII], you're gonna have to take it.
[AGENT][NEUTRAL] OK, hello [PII] and Ms. [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Thank you all so much for holding. I apologize for that wait. So looking at the policy,
[AGENT][NEUTRAL] There's no coverage for like behavior health on her second day on this hospital indemnity policy. Um, I, so there is a benefit like an outpatient sickness rider, which is 4 visits per calendar year at $25 but that's like for the urgent care, emergency room physician office. It's not for um
[AGENT][NEUTRAL] Like behavior or behavior health or, you know, um mental health facility. So I'm just sorry all the way around that the wrong information was given just completely. Um, this would have to be billed to her major.
[CUSTOMER][NEUTRAL] OK, OK, so she'll just be responsible for the $40 co-pay for her Blue Cross Blue Shield.
[AGENT][POSITIVE] Yes, ma'am. I'm so sorry that this, that information was given. Um, I was calling to try to help and then I'm like, what? So I apologize, um, that that was completely wrong.
[CUSTOMER][NEUTRAL] So that's OK, um, but also she had given me a claims address for IMA which is different than the claims address that is on Ms. [PII]'s um card.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The on her hospital indemnity card or the Blue Cross Blue Shield?
[CUSTOMER][NEUTRAL] The hospital deity.
[AGENT][NEUTRAL] So the IMA, yes, it should, hold on one second. Who gave you that, the rep that you talked to?
[CUSTOMER][NEUTRAL] Um, yes, EV gave me the rep that I talked to gave me the IMA claims address, and then, uh, I, but I have Ms. [PII]'s card that I'm looking at as well and her card is showing.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it has a [PII].
[CUSTOMER][NEUTRAL] He PO, yes, correct, yes, [PII] [PII], yes.
[AGENT][NEUTRAL] Yes, that's the correct mailing address. There are some hospital indemnity policies that use IMA for like re-pricing, but that's not this type of policy. I'm gonna get with my um team lead so we can do some coaching on this with the rep, but um no, that this, this hospital indemnity policy, um, the the claims will come to us at APL, which is the [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Alright, well, I wish I had better news for you, Ms. [PII]. I'm so sorry for all the confusion.
[CUSTOMER][NEUTRAL] Oh, that's OK, that's fine. I understand.
[CUSTOMER][NEUTRAL] Um, do you have a good a good call reference number, [PII]?
[AGENT][NEUTRAL] So we don't have call reference numbers, but you can use my name and today's date, and the first initial to my last name is [PII].
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][POSITIVE] Awesome alright thank you so much and I really appreciate you clearing that up.
[AGENT][POSITIVE] You're very welcome, Ms. [PII]. Was there anything else I can help you with?
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][POSITIVE] No, that's great thank you both so much. I, I have, I have one question. I'm sorry.
[AGENT][NEUTRAL] Sure. Yeah, you're fine.
[CUSTOMER][NEUTRAL] What, um, will this, uh, Ms. [PII], Ms. [PII] was in the hospital, will it cover those visits?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Because it was in the hospital.
[AGENT][NEUTRAL] Now, if she, so for the hospital, she does have a um daily hospital benefit. If she's confined to the hospital like any time over its 18 consecutive hours, the policy will pay, um, you know, per day for that hospital confinement. There's no like max or anything of the number of days or if there's a surgery in the hospital or anything, she has coverage for that, um.
[AGENT][NEUTRAL] And let me see what else is in the hospital.
[AGENT][NEUTRAL] The very first time, like if she does have to go to the hospital or has already been this year, um, there is a first occurrence um hospital rider for like when you, that first time she's admitted that would pay up to $500 for that.
[AGENT][NEUTRAL] First visit there.
[CUSTOMER][NEUTRAL] OK, OK, and that is for a regular hospital visit or like a mental health hospital visit. It's the same thing because there, it's just the hospital?
[AGENT][NEUTRAL] Like, hold on one second.
[AGENT][NEUTRAL] But it was a, it was a regular hospital though, right?
[AGENT][NEUTRAL] Or is it like an outpatient? OK. So yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It was a regular hospital.
[AGENT][NEUTRAL] If she was confined to a hospital in this calendar year, um, and the confinement was over the 18 hours, then yes, she could take advantage of that first occurrence um hospital rider.
[AGENT][NEUTRAL] If she was, she was impatient.
[CUSTOMER][NEUTRAL] It was in December.
[CUSTOMER][NEUTRAL] It was in December of last year.
[AGENT][NEUTRAL] Let me see if you use the benefits for last year.
[CUSTOMER][NEUTRAL] I don't think so. I didn't have a hospital visit.
[CUSTOMER][NEUTRAL] I hadn't been in the hospital before.
[AGENT][NEUTRAL] Yeah, I don't see that that benefit was used for last year. So there's no um there's no like timely filing or anything. So if you did still want to file a claim for that, you could.
[CUSTOMER][NEUTRAL] OK, yeah, it, it should, it's still out, so I don't think that we've gotten it back from Blue Cross Blue Shield yet.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] So, um, so once that happens then we will send it to y'all and I will fix this PO box in our system.
[CUSTOMER][NEUTRAL] To the correct one.
[AGENT][NEUTRAL] Yes. Mhm. And I just want to make sure, so she was, she was in the hospital as an inpatient.
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, then, yes, that, that, that first occurrence um benefit would come into could come into play there once they get everything and examine it.
[CUSTOMER][POSITIVE] OK awesome.
[CUSTOMER][POSITIVE] Well thank you very much and I really appreciate it.
[AGENT][POSITIVE] You're very welcome. I'm so sorry. And um I wanted to check the confinement. How long was she in the hospital?
[CUSTOMER][NEUTRAL] 9 days.
[AGENT][NEUTRAL] OK, because confinement on this policy, I just double-checked is um at least 24 continuous hours, so either way she's over that.
[CUSTOMER][NEUTRAL] Monday
[CUSTOMER][NEUTRAL] OK, and it was also, um, you, um, Ms. [PII], you were in the hospital on on [PII], right? And then you left on [PII] I'm sorry, um, [PII] and you left [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] So she had, you know, a day maybe, yeah, that would go for this year also, so I would get it for this year too.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][MIXED] Perfect and um but y'all have a um what's y'all payer ID for y'all's for APL?
[AGENT][NEUTRAL] So it's 60.
[AGENT][NEUTRAL] 801.
[CUSTOMER][NEUTRAL] 60801. OK.
[CUSTOMER][POSITIVE] Alright, awesome well again thank you and I think I think that is all my questions. I'm sorry about that.
[AGENT][POSITIVE] Oh, you're totally fine. Um, was there anything else I can help you out with?
[CUSTOMER][POSITIVE] That sounds great to me.
[CUSTOMER][NEUTRAL] I'm, that would be 1000 then, right?
[AGENT][NEUTRAL] Right, it would be 5 for 2024 and then 5 for this year, for 2025.
[CUSTOMER][NEUTRAL] OK, that
[CUSTOMER][POSITIVE] That's, that's awesome. I mean,
[CUSTOMER][POSITIVE] That, you know, it's gonna, that that'll help. Yeah, that'll help.
[AGENT][NEUTRAL] But then you have on top of that.
[AGENT][NEUTRAL] On top of that, um, 5 $500 you also have that daily, the hospital confinement benefit that pays up to $30 a day after the [PII] 24 hours.
[CUSTOMER][POSITIVE] Oh, OK, cool.
[AGENT][NEUTRAL] So it'll be kind of both of them once they, you know, examine everything.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Every little bit's gonna help.
[AGENT][POSITIVE] It sure does.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] All right.
[CUSTOMER][POSITIVE] My husband will be relieved.
[CUSTOMER][NEUTRAL] Yes, I am.
[CUSTOMER][POSITIVE] Alright, well, uh, thank, thank you both for getting it straight straightened out and but I think that should be all, it should be all.
[AGENT][POSITIVE] All right. Well, thank you all so much for calling APL. I hope you have a great rest of the week and happy [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Thank you and thank you [PII].
[AGENT][POSITIVE] You're very welcome. Bye-bye.
[CUSTOMER][NEUTRAL] All right. Bye, bye bye.