AccountId: 011433970860
ContactId: 5e53ab9e-82b9-41c5-ac6e-f9dbb6374e39
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 485369 ms
Total Talk Time (AGENT): 194127 ms
Total Talk Time (CUSTOMER): 138786 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/5e53ab9e-82b9-41c5-ac6e-f9dbb6374e39_20250217T21:36_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes ma'am, I was calling to check and see about um benefits and eligibility on a patient.
[AGENT][NEUTRAL] OK, I can help you with the benefits and eligibility for a patient. Can I please get your name, your callback number, and the facility you're calling from?
[CUSTOMER][NEUTRAL] [PII] [PII] and I'm calling from Sheehan Counseling Center.
[AGENT][NEUTRAL] OK, thank you, Ms. [PII]. And then what is your um patient's name?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, and what is [PII]'s date of birth and policy number?
[CUSTOMER][NEUTRAL] Um, the date of birth is [PII].
[CUSTOMER][NEUTRAL] And the policy number is 02594107.
[AGENT][NEUTRAL] OK, and Ms. [PII], this phone number that you gave me, um, that is a good number if we get disconnected I'll be able to call you back on?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] OK, awesome. OK, thank you. All right, I do see that [PII] does have an active policy with us.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Her effective date is [PII].
[CUSTOMER][NEUTRAL] Um, I'm sorry.
[CUSTOMER][NEUTRAL] Is it, does it, does this insurance policy cover [PII]?
[AGENT][NEUTRAL] Oh, I don't have a [PII]. Let me look and see.
[CUSTOMER][NEUTRAL] As well as [PII].
[AGENT][NEUTRAL] No, [PII] is not on this policy only [PII].
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Not on the policy.
[CUSTOMER][NEUTRAL] I'm just making notes here.
[CUSTOMER][NEUTRAL] Um, what could you tell me what the benefits are?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] For this plan?
[AGENT][POSITIVE] Yes ma'am, let me finish my note here real quick and I'll go right back to it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so this is a hospital indemnity plan. It's a limited plan and this is just to verify the coverage. It's not a guarantee of payment.
[AGENT][NEUTRAL] The insured has a hospital admission benefit amount one day per calendar year if she goes into the hospital of 50.
[AGENT][NEUTRAL] $100
[AGENT][NEUTRAL] She also has a daily confinement benefit up to 30 days per calendar year of $50.
[AGENT][NEUTRAL] Um, she has outpatient accident or sickness treatment benefit for ER urgent care center.
[AGENT][NEUTRAL] Uh, for physical therapy or physician's office of $50.
[AGENT][NEUTRAL] Um, she has an outpatient prescription drug.
[CUSTOMER][NEUTRAL] Um, does this, does this policy have, um, I'm sorry, your phone keeps breaking up a little bit. I feel like I'm interrupting you.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] Does this um policy cover?
[AGENT][NEUTRAL] No, I'm sorry.
[CUSTOMER][NEUTRAL] That's OK. Does it, excuse me, does it cover mental health?
[CUSTOMER][NEUTRAL] Outpatient?
[AGENT][NEUTRAL] Let me look on her policy. Let me pull up the policy itself and see if it has anything in there about mental health.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's gonna be a minute so it can.
[AGENT][NEUTRAL] The computer can pull it in for us.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and I'm gonna need to scroll through and look and see so it's gonna be just a moment while I read the policy to see if there's anything in there for mental health.
[CUSTOMER][NEUTRAL] OK, that's fine.
[AGENT][NEUTRAL] OK. If she goes inpatient, it does have mental or emotional disorder for neurosis, uh,
[AGENT][NEUTRAL] Psychoneurosis, psychotherapy, psychosis, or mental or emotional disease or disorder of any kind for inpatient. Let me see if the physician's office does.
[AGENT][NEUTRAL] What kind of facility are you in office, a physician's office?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, let me look.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] Yeah, oh, you're fine.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, it does have an exclusion on the policy for mental or emotional disorders without demonstratable organic disease.
[CUSTOMER][NEUTRAL] So, um, so does it cover anything for outpatient?
[AGENT][NEUTRAL] It does not look like it does. No, ma'am.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I, I couldn't remember if [PII] is her wife, so I couldn't remember if she said she had already added her to the policy or was going to add her to the policy, um, but I wanted to check just so that I can, you know, give her a heads up about being covered and you know what her.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] What her um visits would look like because she doesn't uh she does self pay right now so.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] Um, are we, well, I guess it wouldn't matter if we're in network with y'all or not if if that policy doesn't cover.
[CUSTOMER][NEUTRAL] Outpatient visit.
[AGENT][NEUTRAL] Right. It does inpatient but not outpatient, um.
[AGENT][NEUTRAL] Yeah and she's not on the policy either so.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[CUSTOMER][POSITIVE] OK, well I thank you so much and I appreciate your time.
[AGENT][POSITIVE] You're very welcome. Oh, you're so welcome. You have a good day and thank you for calling APL.
[CUSTOMER][POSITIVE] You're welcome and you have a good one too bye.
[AGENT][NEUTRAL] Bye bye.