AccountId: 011433970860
ContactId: 49931612-00b7-46e4-8738-f8cee4c2e006
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 364309 ms
Total Talk Time (AGENT): 173201 ms
Total Talk Time (CUSTOMER): 100667 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/49931612-00b7-46e4-8738-f8cee4c2e006_20250211T19:51_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. This is [PII] calling from Nicholas Child's Hospital.
[AGENT][NEUTRAL] I'm sorry, what was your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] Can you spell your name, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And uh what is your callback number, please?
[CUSTOMER][NEUTRAL] You know, the call back number is.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] [PII] with [PII] [PII].
[AGENT][POSITIVE] Thank you, and [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Uh, I just stated about the uh eligibility and benefit for the patient, [PII].
[AGENT][NEUTRAL] OK, you're needing eligibility and benefits for one member, is that correct?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yes, ma'am. I can help you with that. And what is the policy number for the patient?
[CUSTOMER][NEUTRAL] Sure. The policy number is 01978559.
[AGENT][NEUTRAL] OK, thank you. Give me a moment to get all the member's information pulled up please. One moment.
[CUSTOMER][POSITIVE] Mm thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And any information that I do provide for you today would be a verification of benefits and not a guarantee of payment there. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah. The patient name is [PII], the first name and the last name is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I do show she is a dependent covered under the supplemental policy, and the supplemental policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of benefit information are you needing for hervera inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, for outpatient.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Office visit, specialist office visit, and uh this is for mental health benefits.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, so under this supplemental policy office visits are not covered.
[CUSTOMER][NEUTRAL] OK. Outpatient specialist visit for the mental health benefits.
[AGENT][NEUTRAL] Office
[AGENT][NEGATIVE] Office visits are not covered.
[AGENT][NEUTRAL] Under this supplemental policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, yeah, I just need of outpatient visit only like specialist office.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, again, this is a supplemental policy, Vera. This is not their primary health care insurance. This is only a supplement and the supplemental policy does not cover office visits.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] They, this policy does have an office treatment rider in which treatment can be reviewed under the outpatient benefit max per calendar year per covered insured for covered outpatient services, which is $7350.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And, but again, an office visit is not covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] At all under this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Is this a mental health benefits?
[AGENT][NEUTRAL] There's, it's not differentiated.
[AGENT][NEGATIVE] Visits are not covered.
[AGENT][NEUTRAL] You said it was for an office visit for mental health.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] Outpatient specialist specialist office.
[AGENT][NEUTRAL] Yes, ma'am. Office specialist office visits, primary care office visits, office visits are not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You know, if you will be filing a claim with APO when you do, you will need to submit also the primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And then we do have a portal once we have processed our claim in which you can check claim status by going to [PII].
[CUSTOMER][NEUTRAL] Mhm. So.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And also, I just, I need to clarify this, uh, does it covers the primary.
[CUSTOMER][NEUTRAL] Primary plans.
[CUSTOMER][NEUTRAL] When
[AGENT][NEUTRAL] For covered services, and under this policy.
[AGENT][NEGATIVE] Office visits are not covered.
[CUSTOMER][NEUTRAL] OK, may I get the call reference number with your name?
[AGENT][NEUTRAL] Again, you would use my name that I gave you along with today's date.
[CUSTOMER][NEUTRAL] Could you please spell your name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] OK, thank you so much, [PII]. OK, that's confirmation.
[AGENT][POSITIVE] You're welcome there. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] But now, good for now. Thank you.
[AGENT][POSITIVE] You're welcome and thank you again for calling APL. I hope you have a nice afternoon.
[CUSTOMER][NEUTRAL] Mhm