AccountId: 011433970860
ContactId: 5b70b33d-365c-4c0d-80e0-4fb5ff6468b2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 343399 ms
Total Talk Time (AGENT): 149236 ms
Total Talk Time (CUSTOMER): 147185 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/5b70b33d-365c-4c0d-80e0-4fb5ff6468b2_20250313T13:35_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII]. I'm calling from a mental health facility to get eligibility and specific mental health benefits for a member.
[AGENT][NEUTRAL] I can verify benefits and eligibility. May I have a policy number?
[CUSTOMER][NEUTRAL] Um, yes, uh, it is 023343778.
[AGENT][NEUTRAL] May I have a good callback number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, this is for [PII], uh, [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. Please be advised that verification of coverage does not guarantee the payment of a claim.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Policy is effective [PII] and it is active.
[AGENT][NEUTRAL] Which benefit can I provide for you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, and um is it OK if I get the plan type and coordination of benefit details as well?
[AGENT][NEUTRAL] This is their secondary or gap plan.
[AGENT][NEUTRAL] This is the Metlink, M E D L I N K. So it follows their primary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mein, OK, got it. And is this like an HMO or PPO?
[AGENT][NEUTRAL] There is no network they can utilize any provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got you. And then, yeah, as far as the benefit oh and then one more question, do you know if this plan was active during um last year?
[AGENT][NEUTRAL] Let me verify.
[CUSTOMER][NEUTRAL] Like from January.
[CUSTOMER][NEUTRAL] From January to October.
[AGENT][NEUTRAL] No, ma'am. It became effective [PII].
[CUSTOMER][NEUTRAL] OK, but no, I mean like was it active last year, so it ended in [PII] and then restarted again this year?
[AGENT][NEUTRAL] Oh, no, ma'am. It's continuous, it's year to year, it's continuous.
[CUSTOMER][NEUTRAL] OK, got it. um, it's because they were discharged, so I don't know if the admissions team was asking for additional questions, but yeah, as far as the benefits go, I would like mental health facility billing benefits, um, for both in and out of network for PHP and IOP levels of care, um, and the place of service would be telehealth.
[AGENT][NEUTRAL] OK, so let me get that pulled up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So under this plan, the telehealth would be an as an office visit and this policy does not have office visit benefits.
[AGENT][NEUTRAL] Let's see if there's any inpatient.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] If they're ever confined, that is.
[CUSTOMER][NEUTRAL] Cause there are outpatient levels of care, so the plans, do they have outpatient benefits or?
[AGENT][NEUTRAL] They do have outpatient and they do have the office treatment if you actually go into the office.
[AGENT][NEUTRAL] They do have those benefits. It falls under the outpatient calendar year benefit amount of $3000.
[CUSTOMER][NEUTRAL] OK, yeah
[CUSTOMER][NEUTRAL] OK, that's the deductible limit, 3000?
[AGENT][NEUTRAL] This plan will pick up the co-pays the co-insurance and our deductible up to the 3000.
[CUSTOMER][NEUTRAL] OK, what was the 3000 I'm saying? What is that for?
[AGENT][NEUTRAL] It will pick up the co-pays, the co-insurance, and our deductible. That is the benefit max for outpatients.
[CUSTOMER][NEUTRAL] OK, so you're saying the insurance will cover up to 3000?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, so what is the co-pay or co-insurance amount?
[AGENT][NEUTRAL] There is no co-pay or co-insurance on this plan?
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Insurance
[CUSTOMER][NEUTRAL] Uh, so it's no co-pay or co-insurance covered up to $3000.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, for both in and out of network or it's just one network for both?
[AGENT][NEUTRAL] There's no network.
[CUSTOMER][NEUTRAL] There's no network OK and then um there's no deductible or out of pocket limit, right?
[AGENT][POSITIVE] Correct. This plan just picks up, it follows the primary, it picks up the co-pays, the co-insurance, and our deductibles.
[CUSTOMER][NEUTRAL] OK, and then is so are virtual visits covered like if it's billed as telehealth?
[AGENT][NEGATIVE] No, ma'am, it would not be covered. They do not have the office visit benefit.
[CUSTOMER][NEUTRAL] OK, yeah, this is a bit weird. OK, um, I'll let the staff know. So, yeah, so telehealth is not covered and what about just overall mental health, PHP and ILT? That's
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, it would be covered, just not unless she is actually he or she is impatient.
[CUSTOMER][NEUTRAL] OK, but it's
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If they're inpatient, they will cover up to 30 days.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Impatient.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] OK. All right. um, if I can just get your name and a call reference, thank you.
[AGENT][NEUTRAL] It will be [PII] Last initial is [PII] along with today's date.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] [PII], you're so welcome. And thank you for calling American Public Life. Have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] You too.