AccountId: 011433970860
ContactId: 4bd6fc5d-55fa-45b4-9aa4-93c1aa5d076e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 348290 ms
Total Talk Time (AGENT): 114224 ms
Total Talk Time (CUSTOMER): 151115 ms
Interruptions: 1
Overall Sentiment: AGENT=1.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/4bd6fc5d-55fa-45b4-9aa4-93c1aa5d076e_20250313T14:50_UTC.wav
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[AGENT][POSITIVE] Good Morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, I'm [PII] calling you on behalf of Ventree Medical Associates to have the eligibility and benefits status. How we doing today?
[AGENT][POSITIVE] I'm fine, um, and I hope you're doing as well. And your name is one more time, I'm so sorry, you said it pretty fast.
[CUSTOMER][NEUTRAL] Sure. It's [PII]
[AGENT][POSITIVE] Awesome. Thank you, Ms. [PII]. And what is that policy number, please?
[CUSTOMER][NEUTRAL] 01622812 M as in Mike L as in Lima 8.
[AGENT][POSITIVE] Thank you so much. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Hey
[CUSTOMER][NEUTRAL] Sure. It's [PII] with the extension number [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And Ms. [PII], verify that patient's name, date of birth.
[CUSTOMER][NEUTRAL] [PII] and the date of birth is on [PII].
[AGENT][POSITIVE] OK, thank you so much. And you say you're calling to verify eligibility and benefits, correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. I'm showing his effective date is [PII].
[CUSTOMER][NEUTRAL] Ok.
[AGENT][NEUTRAL] He is active on the policy and what benefits are you needing for this patient?
[CUSTOMER][NEUTRAL] So it's for mental health outpatient visit. May I know does the patient plan covers primary co-insurance and deductible?
[AGENT][NEUTRAL] Well, it picks up what primary applies towards deductible, co-pay or co-insurance for service in an outpatient facility or inpatient in the hospital. And you say you're calling for mental health. Is this for an office visit?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, it's for telehealth.
[AGENT][NEUTRAL] Well, I know that
[AGENT][NEUTRAL] Well, under the patient's policy, office visits are not covered.
[CUSTOMER][NEUTRAL] For telehealth, does the patient plan covers telehealth?
[AGENT][NEUTRAL] No, ma'am, because that would be considered an office visit and office visits are not covered under the plan.
[CUSTOMER][NEUTRAL] OK. So for reference, like, does the patient plan covers telehealth benefits?
[AGENT][NEUTRAL] No, ma'am. If it's for an office visit, no, it's not covered.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No, it's not for office visits, it's for telehealth, televisit, virtual visit.
[AGENT][NEUTRAL] It's still an office visit, which is not covered on the policy.
[CUSTOMER][NEUTRAL] I don't know.
[CUSTOMER][POSITIVE] Oh, thank you. And
[CUSTOMER][NEUTRAL] Is this a secondary payer for this member?
[AGENT][NEUTRAL] We are secondary.
[CUSTOMER][NEUTRAL] Oh thank you, but I see for this member, previously the payment has been received for the insurance.
[AGENT][NEUTRAL] OK, what was that date of service and the amount of the charge?
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Sure, it's on [PII] and the date of, like the bill amount is $150 even.
[AGENT][NEUTRAL] No, ma'am. Uh, shall we receive a claim for that data service and that process as the office visits are not covered.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] OK. Can you please give me a moment while I get a claim?
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] So, like on [PII], we just received a payment of $10.
[CUSTOMER][NEUTRAL] From American Public Life Insurance.
[AGENT][NEUTRAL] Was it for this patient?
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Because I don't show we received any claim from [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, just a moment while I get that information. Just a moment.
[CUSTOMER][NEUTRAL] I think that.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yes, it's for [PII]. The bill amount is for $400 even.
[AGENT][NEUTRAL] I'm sorry, what was that data service again?
[CUSTOMER][NEUTRAL] It's for [PII].
[AGENT][NEUTRAL] [PII], OK.
[CUSTOMER][POSITIVE] And the bill amount is for $400 saving.
[AGENT][NEUTRAL] Yeah, that was for a procedure in office. It wasn't for the office visit charge.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] So, for office visit, the patient plan does not cover any
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Correct, office visits are not covered per the policy.
[CUSTOMER][NEUTRAL] Plan, right?
[CUSTOMER][POSITIVE] OK, thank you so much. And could you please spell your name for my reference?
[AGENT][NEUTRAL] Sure, it's [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And is there any call reference number for this call?
[AGENT][NEUTRAL] Uh, you may use my name in today's date, and is there anything else, Ms. [PII], I can assist you with?
[CUSTOMER][POSITIVE] No, this is more than enough. Thank you so much. Have a great day. Bye-bye.
[AGENT][POSITIVE] You're welcome. You too. Thank you for calling APL. Bye.
[CUSTOMER][NEUTRAL] You too.