AccountId: 011433970860
ContactId: 3ac00422-a729-41c8-9bfd-65890d61f11a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 640619 ms
Total Talk Time (AGENT): 231962 ms
Total Talk Time (CUSTOMER): 210798 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/3ac00422-a729-41c8-9bfd-65890d61f11a_20250305T17:22_UTC.wav
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[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] I'm sorry ma'am, what was your name?
[AGENT][NEUTRAL] My name is [PII] as well.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Oh, I'm sorry. So, yes, hi, [PII], uh, my name is [PII] from Kyo Autism Therapy.
[AGENT][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Um, I just got.
[CUSTOMER][NEUTRAL] On the phone with uh a previous agent. He's actually asking me for the policy number.
[CUSTOMER][NEUTRAL] Which I cannot provide earlier that's why I called back um I'm trying to.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, ask a few questions regarding submitting an authorization.
[AGENT][NEUTRAL] OK. Um, may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and um let's see, so you do have a policy number now, Mr. [PII]?
[CUSTOMER][NEUTRAL] Um, yes.
[AGENT][NEUTRAL] OK, what is that policy number?
[CUSTOMER][NEUTRAL] Um, policy number is 02458.
[CUSTOMER][NEUTRAL] 169.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Um, [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and what is your question about this policy?
[CUSTOMER][NEUTRAL] Yes, um, the, the last agent already told me that APL does not require authorization for any APL policies, is that correct?
[AGENT][NEUTRAL] Mhm. That is correct. We don't have any major medicals. Um, we have either limited or secondary policies. In this case, this is a hospital indemnity policy, which is a limited policy.
[CUSTOMER][NEUTRAL] OK. That's, that's include uh ABBA services for behavioral health.
[AGENT][NEUTRAL] You want to know if behavioral health is covered?
[AGENT][NEUTRAL] Mr. [PII]
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, I can check and see. One moment.
[AGENT][NEUTRAL] Let me pull it.
[AGENT][NEUTRAL] OK, it's gonna be a minute. I'm waiting on the benefits to pull up.
[CUSTOMER][POSITIVE] Sure, sure, no worries.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] All right, let's
[AGENT][NEUTRAL] Is this going to be for a psychiatrist um visit or no?
[CUSTOMER][NEUTRAL] For applied behavioral analysis.
[CUSTOMER][NEUTRAL] Um, I can give you the diagnosis code and the CPT codes if you want.
[AGENT][NEUTRAL] OK. Um, no, I don't need that, but is it, um, what type of doctor is this person gonna see? Is it a psychologist, psychiatrist, um,
[AGENT][NEUTRAL] Counselor, what, what type of um doctor?
[CUSTOMER][NEUTRAL] Um, it, it's, it's for BCBA.
[AGENT][NEUTRAL] OK. What doctor, what, what licensed doctor is gonna be seeing this doctor, this member, this insured?
[CUSTOMER][NEUTRAL] Uh, it's a like a board certified behavioral analysis.
[AGENT][NEUTRAL] Um, it's not covered then.
[AGENT][NEUTRAL] It's not gonna be covered. This policy again is a limited hospital indemnity plan. Um, with this one, if the member goes to a psychiatrist, it's covered as an office visit under the office visit benefit, but that will be the only uh licensed doctor that we will cover for behavioral health or mental health. It will be only a psychiatrist.
[AGENT][NEUTRAL] And that will be part of that $75 per visit maximum of 5 visits per covered person per calendar year, and this is not a guarantee of payment, just a verification of coverage that is the benefit under this policy and this is a limited policy again.
[CUSTOMER][NEUTRAL] That that's for the member's policy. It's only limited.
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][NEUTRAL] But not all members have limited policy. Is that what you mean?
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] That's correct. We have many products.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] One moment, let me just.
[AGENT][NEUTRAL] Mhm. Sure.
[CUSTOMER][NEUTRAL] However.
[CUSTOMER][NEUTRAL] Member has on DVD.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I'm sorry. um, can you repeat the, the one that you said it's only psychiatrist?
[AGENT][NEUTRAL] Yes, if the member goes to a psychiatrist, then it will be part of that office visit benefit, which is $75 per visit, maximum of 5 visits per person per calendar year combined.
[CUSTOMER][NEUTRAL] Why don't we submit or try to submit and then if it's covered then you just need to make a decision if it's not.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] You, you can always do that. Yes. Mhm. Yeah. Mhm.
[CUSTOMER][NEUTRAL] Uh, would that be OK? OK, yeah. Um, it's all right. The, the only, uh, the next question is what's your payer ID?
[CUSTOMER][NEUTRAL] For this member?
[AGENT][NEUTRAL] OK, uh, for this type of policy, bear with me just a second, let me pull that information.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK. Yeah.
[AGENT][NEUTRAL] OK, so this one will go to IMA before it comes to us, so that will be [PII].
[AGENT][NEUTRAL] [PII], with the payer ID of 64556.
[CUSTOMER][NEUTRAL] 64556. I'm sorry, I didn't catch the address that's where do we submit claims, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, that's [PII]. OK.
[CUSTOMER][NEUTRAL] One moment, one moment.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], yes, [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] That's [PII].
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] This is for [PII], right?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] Again, the address is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh, I'm sorry, [PII].
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][NEUTRAL] Alright and then um so lastly any additional authorization submission details that you wish to share with us?
[AGENT][NEUTRAL] Authorization is not required because it's a limited policy.
[CUSTOMER][NEUTRAL] Uh, that's not.
[CUSTOMER][NEUTRAL] Because I see it.
[CUSTOMER][NEUTRAL] 5
[CUSTOMER][NEUTRAL] And you mentioned just to confirm again, just wanna make sure uh it's correct. Since the member has only limited privacy, she can only get office visit benefits, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, and that will be for a, um, yes, go ahead.
[CUSTOMER][NEUTRAL] With
[CUSTOMER][NEUTRAL] Go ahead, go ahead, go ahead.
[AGENT][NEUTRAL] And that will be only for a psychiatrist. We do not cover um counselors or psychologists.
[CUSTOMER][NEUTRAL] Of course.
[AGENT][NEUTRAL] It's just psychiatry.
[CUSTOMER][NEUTRAL] OK, please
[CUSTOMER][NEUTRAL] This is for behavioral health benefits.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] uh
[CUSTOMER][NEUTRAL] Benefits.
[CUSTOMER][NEUTRAL] Alright, um, I'm actually.
[CUSTOMER][NEUTRAL] It's all good now. Do you have like a call reference number?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][POSITIVE] OK, thank you so appreciate that.
[AGENT][POSITIVE] You're welcome. No problem. Is there anything else I'm gonna help you with today?
[CUSTOMER][POSITIVE] I'm good and good thank you.
[AGENT][POSITIVE] You're welcome and thank you for calling APO. Have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you, ma'am.