AccountId: 011433970860
ContactId: 3176a672-e4d7-4fc5-b42d-27bf57138ae1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 267679 ms
Total Talk Time (AGENT): 119486 ms
Total Talk Time (CUSTOMER): 89981 ms
Interruptions: 1
Overall Sentiment: AGENT=0, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/3176a672-e4d7-4fc5-b42d-27bf57138ae1_20250304T20:27_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hey, good evening. My name is [PII]. So, could you please help me with the patient eligibility and benefits?
[AGENT][NEUTRAL] Sure, I can verify benefits and eligibility for you and your name is again?
[CUSTOMER][NEUTRAL] [PII], and my last initial first name is [PII].
[AGENT][NEUTRAL] OK, and [PII], what is the policy number, please?
[CUSTOMER][NEUTRAL] Mm. All right. The policy number is 02596755.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[AGENT][NEUTRAL] OK. And [PII], verify that patient's name, date of birth.
[CUSTOMER][NEUTRAL] Sure. It's uh [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. I'm showing her effective date is [PII] at [PII]. She is active on the policy and what benefits are needing for this patient?
[CUSTOMER][NEUTRAL] Uh, so basically I need a benefit for mental health provider outpatient.
[AGENT][NEUTRAL] OK, let me see if that's covered. Give me one moment, please.
[CUSTOMER][POSITIVE] No worries. Take your time.
[CUSTOMER][NEUTRAL] And could you please verify one more thing, uh, is that provider is a network or out of network so we can get to know what benefits should we get?
[AGENT][NEUTRAL] Uh, we don't have a network.
[AGENT][NEUTRAL] So the policy is open to where they can go to any provider.
[CUSTOMER][NEUTRAL] Oh,
[AGENT][NEUTRAL] And give me one.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] You said for mental health?
[CUSTOMER][NEUTRAL] Yes, mental health provider, outpatient.
[AGENT][NEUTRAL] Uh, it's not covered under the policy. It is an exclusion.
[CUSTOMER][NEUTRAL] Mhm. And what kind of benefits is covering under the patient, uh, insurance?
[AGENT][NEUTRAL] Not for mental health because like I said, it's an exclusion on the policy. The policy has benefits for sickness or an injury.
[AGENT][NEUTRAL] In office, outpatient.
[AGENT][NEUTRAL] Um, wait one moment.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, now I get to know. Could you please, uh, give me that office outpatient benefit?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Well, if it's in relation to mental health, it's not going to be covered, but I can give you office visit benefits.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] OK, um, not a guarantee of payment, just a verification of coverage. Insured has a benefit that pays up to $50 per day for an office visit, a total of 4 visits per year.
[CUSTOMER][NEUTRAL] And $50 for the per visit copay. Uh, no, 570.
[AGENT][NEUTRAL] That's the benefit max that we pay of $50 per visit up to 4 visits per year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right. So, is there any patient responsibilities?
[AGENT][NEGATIVE] We don't give patient responsibility.
[CUSTOMER][NEUTRAL] It's a 100% coverage.
[AGENT][NEUTRAL] As I stated, the policy pays for a sick office visit, $50 per day, up to 4 visits per year. We don't give patient responsibility.
[CUSTOMER][NEUTRAL] All right. So, is there any out of pocket max?
[AGENT][NEUTRAL] Now,
[CUSTOMER][NEUTRAL] All right. So could you please give me the payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] And could you please verify me the plan type?
[AGENT][NEUTRAL] It's a limited medical indemnity plan.
[CUSTOMER][NEUTRAL] All right. And the reference number?
[AGENT][NEUTRAL] We don't give reference numbers. If you like, you may use my name in today's date, and is there anything else I can assist you with today?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] No, you assist me very well. Thank you so much for your assistance. Have a good day.
[AGENT][POSITIVE] You're welcome. Mhm. Thank you for calling APL. Bye.