AccountId: 011433970860
ContactId: 6a036460-12a7-4de9-93db-517234f3e102
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 691250 ms
Total Talk Time (AGENT): 255811 ms
Total Talk Time (CUSTOMER): 213575 ms
Interruptions: 3
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/6a036460-12a7-4de9-93db-517234f3e102_20250127T20:52_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, so my name is [PII]. I'm a licensed, uh.
[CUSTOMER][NEUTRAL] personal counselor and I'm calling to verify benefits and to find out exactly what I need to do in terms of filing the claims. This is my first, uh, incursion to work with this particular plan.
[AGENT][NEUTRAL] OK, so you say you're a counselor?
[AGENT][NEUTRAL] And you're calling
[CUSTOMER][NEUTRAL] Yes, I'm a licensed professor.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Go ahead.
[AGENT][NEUTRAL] I'm sorry. OK, and you're calling to submit a claim for a um member?
[CUSTOMER][NEUTRAL] I'm trying to figure out how to do that and if I'm in the right place.
[AGENT][NEUTRAL] OK, let's see. Um, may I have a callback number just in case we get disconnected, Mr. [PII].
[CUSTOMER][NEUTRAL] Sure, sure. It's [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Um, do you have a policy number or no?
[CUSTOMER][POSITIVE] Yes, hold on, I think this is the right one. Hold on one second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's going to be
[CUSTOMER][NEUTRAL] Now I was told this might be different for you all, but I have D as in David, 43302266.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. um, yeah, that's not gonna be your number, that's gonna be IMA. Um, what's the name of the patient?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Do you know the address for Ms. [PII]?
[CUSTOMER][NEUTRAL] Yes, it's, it's a mister. Hold on, hold on.
[AGENT][NEUTRAL] Oh, mister, OK.
[CUSTOMER][NEUTRAL] That's what I said too.
[CUSTOMER][NEUTRAL] Uh, let me, OK, let me again.
[CUSTOMER][NEGATIVE] About the second I had to hit somewhere.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] I do it.
[CUSTOMER][POSITIVE] Oh boy, I gotta find it. Bear with me please.
[AGENT][NEUTRAL] Because
[CUSTOMER][NEUTRAL] I just saw it.
[CUSTOMER][NEUTRAL] Oh boy.
[CUSTOMER][NEUTRAL] I gotta dig through all of these emails to get it. I don't have it here.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I just saw it. I can't find it.
[CUSTOMER][NEUTRAL] where
[AGENT][NEUTRAL] What is her date of birth?
[AGENT][NEUTRAL] Or his date of birth, I'm sorry.
[CUSTOMER][NEUTRAL] His date of birth is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I think I found him.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, here's the address here.
[AGENT][NEUTRAL] OK, so I'm gonna go ahead.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] You still need it?
[AGENT][NEUTRAL] Uh, no, I don't need it no more. Um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so I'm gonna go ahead and give you an instruction on how to submit a claim. Um, I cannot guarantee any payments over the phone, um.
[AGENT][NEUTRAL] So what we're gonna need uh for this particular uh policy is an itemized bill.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the address to submit it or the payer ID I'm not sure how you send in claims um are you gonna send it electronic.
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] OK, hold on one second. Let me, let me.
[CUSTOMER][NEUTRAL] Oh hold on one second. Let me get to a place where I can take this information. Give me a couple of seconds, a couple of minutes, really.
[AGENT][POSITIVE] OK, sure, sure, yes, yes, yes, no worries, go ahead, take your time.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So, are you still with me?
[AGENT][NEUTRAL] I'm still here, yes.
[CUSTOMER][NEUTRAL] OK, I'm gonna pass you to my administrative assistant and she's gonna take the information and uh one question I need to ask uh uh this is, this is going to be for behavioral health can you?
[CUSTOMER][NEUTRAL] Will you be able to, is that gonna be the same thing?
[AGENT][NEUTRAL] Uh, well, this is a limited policy, um,
[AGENT][NEUTRAL] More than likely we will have to be looking at all the information including clothes to determine any benefits, um, but it is a limited policy. It's not a major medical.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright, she's gonna take the permission and uh we'll go from there.
[AGENT][POSITIVE] All right, thank you, Mr. [PII].
[CUSTOMER][NEUTRAL] OK, she's gonna tell you how to file a claim for this. I just got to pay.
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. How can I help?
[AGENT][NEUTRAL] Hi, [PII], how are you? This is [PII] with APL um.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] And I'm just gonna go ahead and give you instructions on how to send us a claim. Um, I'm not sure if you send the claims electronically or you send them by paper.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You, I got one question.
[CUSTOMER][NEUTRAL] We normally uh do ability.
[AGENT][NEUTRAL] Really
[CUSTOMER][NEUTRAL] So they're electronic. Mhm.
[AGENT][NEUTRAL] Electronic. OK, so uh we do have a payer ID that you can use if you do electronics. Um, the payer ID is 60801.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and um the members, uh let me give you the member's policy because you didn't have the policy. Um, the policy is 0257.
[AGENT][NEUTRAL] 6309.
[CUSTOMER][NEUTRAL] OK, that's 02576309.
[AGENT][NEUTRAL] Yeah, that's all the numbers. And um like I was telling him, this is a limited hospital indemnity plan. It does have additional benefits, but we cannot guarantee any payments over the phone um or um this is for sickness and illness.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and
[CUSTOMER][NEUTRAL] It's for behavioral health, it's for counseling.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Therapy, mental health.
[CUSTOMER][NEUTRAL] It's not, it's in the office. It's not uh.
[CUSTOMER][NEUTRAL] At a facility.
[AGENT][NEUTRAL] Yeah, again, I cannot say that it will not be paid. I need to, or I, you know, I cannot say it's gonna be pay or it's not gonna be paid. We cannot, we don't process claims over the phone, um, so I can only tell you and give you instructions how to send it. Once you send it, we go over all the information and then we did make a determination if it's gonna be payable or not, um.
[CUSTOMER][NEUTRAL] OK, is there a fax number if we needed to fax in the claim or is there a place where we can get a claim form?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, um, you don't need a claim form. I'm not sure what type of form you're gonna be sending in. Is it like a general itemized bill or is it what type of document do you use?
[CUSTOMER][NEUTRAL] Well, when we do it electronically, we just enter the information. That's what I'm asking, do you all have a claim form that we would need to complete?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, the claim form
[CUSTOMER][NEUTRAL] To file a claim.
[AGENT][NEUTRAL] The claim forms we have is for members only, it's not for providers.
[CUSTOMER][NEUTRAL] OK, so if the member needed a claim form, he would be the one to submit the claim.
[AGENT][NEUTRAL] No, um, we do take, um, OK, when we receive claims from providers, they usually send a 1500 form or UV form, um, just a general form, um, but if you're not going to be using a general form, you just send us the itemized bill, um, with the information on who needs to get the payment and all that information, including diagnosis codes, procedure codes, or anything that happened in the list.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And um again, you can send it electronically or you can send it by fax. Um, the fax number is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, with the codes and a copy of the invoice or itemized billing? OK.
[AGENT][NEUTRAL] Yes, the itemized bill with the codes, with diagnosis codes and procedure codes.
[CUSTOMER][NEUTRAL] OK, let's see what else do I need here.
[CUSTOMER][NEUTRAL] We have the payer ID.
[CUSTOMER][NEUTRAL] And there's no way uh we don't have to be in network. He just uses his insurance as needed, right?
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Well, yeah, this is a limited policy like I was telling Mr. um [PII]. Uh, this is not, yeah, well, it's uh we don't have, it's not a major medical, it's just a limited policy. Um, we don't know if he has any other policies out there. It's just a limited policy. Mhm.
[CUSTOMER][NEUTRAL] Well, mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, we'll check on it. Alright, I appreciate your time and you have an awesome rest of your day.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You as well, Miss [PII]. Thank you for calling APL. Have a good afternoon.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. Bye-bye.