AccountId: 011433970860
ContactId: 2c9d01d8-4ac7-408c-81e7-bc015e34e0fd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 231740 ms
Total Talk Time (AGENT): 113132 ms
Total Talk Time (CUSTOMER): 101081 ms
Interruptions: 1
Overall Sentiment: AGENT=2, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/2c9d01d8-4ac7-408c-81e7-bc015e34e0fd_20250408T20:59_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, um, I am a behavioral health provider, um, and one of my, one of my patients has, um, you all as their secondary insurance. Um, I don't believe I'm paneled with you all. I wanted to first check that and then I wanted to find out if I'm not paneled, if I could get authorization to uh work with this member.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure, OK, I can get that policy pulled up and we can take a look. Most the secondary medical um is not affiliated with any sort of network uh they're very dependent on primary, uh, but we can get that pulled up and take a look. What was your name? I'm sorry.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, my name is [PII].
[AGENT][NEUTRAL] OK, [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure it's [PII].
[AGENT][NEUTRAL] OK, thank you. Do you have the member's policy number?
[CUSTOMER][NEUTRAL] I do. It is 02560523.
[AGENT][NEUTRAL] OK, thank you and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Um, the name is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And let me pull, and her date of birth is [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that, [PII]. Uh, so this policy is active. Effective date was [PII]. So yes, in short, this policy is designed to help with uh co-pay, deductible and co-insurance after major medical pays. So as it is very dependent on major medical, if they are not willing to pay, this policy can't. If they are, then this policy can so no authorization or anything like that is required, it just follows major medical guidelines.
[CUSTOMER][NEUTRAL] OK, so, so what I've learned from her primary, um, insurance is they will cover everything but $35 they, they have a $35 co-pay. Um, so what should I then take submit that to you all as I typically would secondary insurance or do I need to do anything different?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, so you could just do it the exact same way. All we really need is that explanation of benefits from them. I will say though, while I've got you, [PII], um, I will just go ahead and check to see if office visits are covered under this policy, so they are all very different as to what they do and don't cover. So bear with me just a moment, let me get that information for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And, and just so you know, it is uh mental health. I know sometimes that changes things.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so this policy does not have coverage for office visits. However, treatment received in office could be covered. I don't know what kind of treatment would be received for behavioral health, um, that would be more for, you know, they were to get an X-ray or something like that.
[CUSTOMER][NEUTRAL] Yeah, this is more it's billed as a um insight oriented psychotherapy code CPT code, so probably not.
[AGENT][POSITIVE] I see. OK, so it's right. OK, yes, that is correct.
[CUSTOMER][NEUTRAL] OK, so, um, that it sounds like that would not be covered.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK alright I just wanna be able to let the member know OK.
[AGENT][POSITIVE] Of course, yeah, sorry about all the confusion.
[CUSTOMER][POSITIVE] That's OK. All right, thank you so much.
[AGENT][NEUTRAL] All right, yeah, was there anything else I could help you with?
[CUSTOMER][POSITIVE] No, that's it thank you.
[AGENT][POSITIVE] Alright, give us a call. Yeah, have a great rest of your day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you. Bye-bye.