AccountId: 011433970860
ContactId: 58305f57-f19e-4e8c-bf48-56206d9e2e70
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 397769 ms
Total Talk Time (AGENT): 142451 ms
Total Talk Time (CUSTOMER): 232351 ms
Interruptions: 3
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/58305f57-f19e-4e8c-bf48-56206d9e2e70_20250529T14:22_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, good morning, [PII]. I'm trying to um verify um some insurance information and see if it's just dental or do they have behavioral health. What all do you need from me to?
[AGENT][NEUTRAL] OK, I can help you with um benefits for a patient. uh first I'll need to get your name and your callback number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure, my name is uh [PII]. Last initial is [PII] Can I get the initial to your last name as well, [PII]?
[AGENT][NEUTRAL] Yes ma'am, it's A.
[CUSTOMER][POSITIVE] Alright, thank you, ma'am.
[AGENT][NEUTRAL] You're welcome. And Ms. [PII], what?
[CUSTOMER][NEUTRAL] And what else did you need?
[AGENT][NEUTRAL] Your callback number?
[CUSTOMER][NEUTRAL] Sure. Area code [PII], direct number.
[AGENT][NEUTRAL] Thank you. And what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] All righty. First name is [PII], last name is [PII]. Date of birth for her is [PII]. The ID number on the call she's presenting is 02617356. On here it says, um, group voluntary dental. So is, is this just a dental plan or does she have behavior health benefits, Ms [PII]?
[AGENT][NEUTRAL] OK, let me check and see if it's just dental or behavioral health for you.
[CUSTOMER][POSITIVE] Sure, no problem.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, yes, ma'am. This policy is only dental.
[CUSTOMER][NEUTRAL] So it's only dental, OK.
[AGENT][NEUTRAL] Yes ma'am, and now she does have a hospital indemnity plan.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me see if it has.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, mental health on it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, she has a hospital indemnity plan and this is just to verify her benefits. It's not a guarantee of payment with outpatient accident and sickness treatment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] In a physician's office and she gets 4 a year that pays $50.
[CUSTOMER][NEUTRAL] OK, so what plan is that different than this American public life or you said she has a voluntary hospital plan?
[AGENT][NEUTRAL] Yes, but it, it.
[AGENT][NEUTRAL] Right, it's American Public Life, and let me give you the policy number for this plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So she, this car she's presenting is only dental.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, so what's her, but she has a, what, and you said that's a.
[AGENT][NEUTRAL] And she has.
[CUSTOMER][NEUTRAL] She has an American public and she does have a, a hospital, you said indemnity plan?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Correct? Oh.
[AGENT][NEUTRAL] And it does have physician office visits on it.
[CUSTOMER][NEUTRAL] OK, and D.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For outpatient.
[AGENT][NEUTRAL] And there's 4 that pays $50.
[CUSTOMER][NEUTRAL] OK, you can, OK, you can go.
[CUSTOMER][NEUTRAL] OK, you're going in and out, um, Mrs. To, so, uh, that's OK. So, um, on that, uh, American Hospital, uh, I guess ademnity plan, so she does have benefits. So is that in-network benefits or out of network benefits, do you know?
[AGENT][POSITIVE] Oh, I'm sorry. I apologize.
[AGENT][NEUTRAL] She can use any provider she wants to use.
[CUSTOMER][NEUTRAL] OK, so she has in-network and out of network benefits, OK.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] All righty. And her co-pay, you said, is how much?
[AGENT][NEGATIVE] She doesn't have a copay. The policy pays $50.
[CUSTOMER][NEUTRAL] OK, so 0 cover.
[CUSTOMER][NEUTRAL] OK, so $50 what, like daily or something or?
[AGENT][NEUTRAL] For each visit, and she gets 4.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] OK, so it pays $50 for each visit, and she's allowed 4.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Correct. All righty. Oh, OK, so that's in, uh, OK, um, let's see here. OK, so it's still American Public Life. Uh, it's the address [PII], [PII]. Is that where the claims go to?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes ma'am, but that um zip code is [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, I'm sorry if I said that wrong, so let me get this.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] And I saw um payer ID, what is the payer ID?
[AGENT][NEUTRAL] It is 60801.
[CUSTOMER][NEUTRAL] This.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All righty. And what is the effective date, um, this tour of this policy?
[AGENT][NEUTRAL] Her effective date is, let me check for you.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, and what is filing deadlines for claims?
[AGENT][NEGATIVE] We do not have a timely filing limit.
[CUSTOMER][NEUTRAL] OK, so you don't have time. OK, so, OK, she has a, uh, I guess, OK, let me verify this, make sure she does have medical benefits on this policy. It's not just dental, correct? I wanna make sure I'm saying that.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, she has a $0 copay, 0 deductible, 0 out of pocket. You guys are only gonna pay $50 office visit, and she's only allowed 4, correct?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, alrighty, and it doesn't matter if it's in network or out of network.
[AGENT][NEUTRAL] That's correct also. Is she gonna go inpatient?
[CUSTOMER][NEUTRAL] Also, ah.
[CUSTOMER][NEUTRAL] Uh, no, this is an outpatient office visit for behavior health. OK, but so she's not required to pay anything. Uh, now, our assessment fee is $250 since she's the intake, but you guys are only gonna pay $50 towards that, correct?
[AGENT][POSITIVE] OK, good.
[AGENT][NEUTRAL] OK, yes.
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] OK, so she's responsible for the rest.
[CUSTOMER][NEUTRAL] Correct? No.
[AGENT][NEUTRAL] Uh, we don't give patient responsibility. We let the provider determine that.
[CUSTOMER][NEUTRAL] OK, no problem. So we probably need a one-time agreement plan or something?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. If you can give me, I guess, a reference number, I think I have all American public life, that's where the claims go to. Filing deadline, you don't have that effective date [PII]. Payer ID is 60801, correct?
[AGENT][POSITIVE] Yes ma'am, that's correct and um.
[CUSTOMER][NEUTRAL] All right, if you can, oh, go ahead, Ms. [PII].
[AGENT][NEUTRAL] Oh yeah, you can use my name [PII] in today's date.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Alrighty, thank you. I appreciate it, Ms. Try. You have a nice day.
[AGENT][POSITIVE] You too, Ms. [PII]. You have a blessed one and thank you for calling APL.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye bye, ma'am.