AccountId: 011433970860
ContactId: 658b20e8-a447-4aed-9f2b-fc03a5803af9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 413750 ms
Total Talk Time (AGENT): 205300 ms
Total Talk Time (CUSTOMER): 107939 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/658b20e8-a447-4aed-9f2b-fc03a5803af9_20250117T21:46_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, my name is also [PII]. Um, I was calling because I, I was calling because we received several denials on a patient and I was trying to figure out if this, it says dental, but the ADA code on the explanation of benefits is a.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Psy, um, code.
[CUSTOMER][NEUTRAL] So I don't know what the discrepancy is.
[AGENT][NEUTRAL] OK, so you've received [PII] from a member?
[AGENT][NEUTRAL] And you have questions on those claims. Is that correct, [PII]? Yes, I can help you with that. Sure. And how do you spell your [PII]? Mhm.
[CUSTOMER][POSITIVE] Right, that's correct.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and mine's [PII] And [PII], what's a good callback number for you, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number?
[CUSTOMER][NEUTRAL] 02520558.
[AGENT][POSITIVE] Thank you. One moment, please.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, [PII], and any information that I do provide would be a verification of benefits and not a guarantee of payment. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, hold on, date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. Now, this policy number that you gave me it is a dental policy.
[CUSTOMER][NEUTRAL] OK, does he have a medical policy?
[AGENT][NEUTRAL] OK just one moment.
[AGENT][NEUTRAL] OK, are you gonna need any information off of that?
[AGENT][NEUTRAL] Dental policy before I get completely out of it.
[CUSTOMER][NEUTRAL] No, mm mm.
[AGENT][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] OK, so I did find a limited benefit plan for him um in which he's also a dependent with a different policy number. The policy number for the limited benefit plan is 252.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 0557.
[AGENT][NEUTRAL] And that policy, Tracy is active, effective 8-12-2024.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] As far as the limited benefits, um, does it cover mental health?
[AGENT][NEUTRAL] Is this for an office visit?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Uh, let me check the benefits on this particular policy. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so on this limited benefit plan.
[AGENT][NEUTRAL] For
[AGENT][NEUTRAL] Outpatient accident and sickness treatment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] There's a physician's office benefit that is $100 per day.
[AGENT][NEUTRAL] And a maximum of 4 days per calendar year per covered person.
[CUSTOMER][NEGATIVE] That's very limited.
[AGENT][NEUTRAL] Mhm. Yes, it is. Mhm. I mean, it is, yes, we are not a major medical carrier.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And this is the, the hospital indemnity with limited benefit plan that they have with us.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's the same policy number.
[CUSTOMER][NEUTRAL] Uh, the same for [PII].
[AGENT][NEUTRAL] Uh, give me a moment.
[AGENT][NEUTRAL] And what is [PII]'s date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, she is also covered. Mhm.
[CUSTOMER][NEUTRAL] And it's under the same policy number?
[AGENT][NEUTRAL] Yes, ma'am, it is. Uh-huh.
[CUSTOMER][NEUTRAL] The 252. OK, alright, I think that's all all I have.
[AGENT][NEUTRAL] Mhm, it is.
[AGENT][NEUTRAL] OK, and then I don't know you if you, you may already be aware of this, [PII], but if you will file a claim with us once it's been processed, we do have a portal that you should be able to access the explanation of benefits.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] From and our portal website is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And do you have?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh, yes, ma'am.
[CUSTOMER][NEUTRAL] OK, all right.
[AGENT][NEUTRAL] And do you have the correct mailing address for claims for this uh limited benefit plan?
[CUSTOMER][NEUTRAL] Um, probably not. I'll take it though.
[AGENT][NEUTRAL] OK, so that would be they will be mailed to IMA that's all capital letters.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. And I can also give you the payer ID if you would like.
[CUSTOMER][POSITIVE] Yes, that would be helpful.
[AGENT][NEUTRAL] OK, and the payer ID is 64556.
[CUSTOMER][NEUTRAL] It's IMA I as in [PII] in [PII] as in [PII].
[AGENT][POSITIVE] Correct. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] [PII], you have been great assistance thank you I appreciate it.
[AGENT][NEUTRAL] The [PII].
[AGENT][POSITIVE] Oh, well, well, you are very welcome. It was certainly my pleasure. So is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No, that's all.
[AGENT][POSITIVE] Alright then, well thank you so much for calling APL and I hope that you have a very nice weekend, [PII].
[CUSTOMER][NEUTRAL] You do the same thanks.
[AGENT][POSITIVE] Thank you. Yes, ma'am. Thanks.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Papa