AccountId: 011433970860
ContactId: 6fa0cbed-482b-4254-8cc2-bf552f781974
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 435359 ms
Total Talk Time (AGENT): 206471 ms
Total Talk Time (CUSTOMER): 105504 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/6fa0cbed-482b-4254-8cc2-bf552f781974_20250408T13:16_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good morning, [PII]. This is [PII] calling from Micklas Children's Hospital.
[AGENT][NEUTRAL] Hi, how are you?
[CUSTOMER][POSITIVE] Yeah, doing good. What about you?
[AGENT][POSITIVE] I'm doing well. How may I assist you today?
[CUSTOMER][NEUTRAL] Yeah, I just need to know about uh the patient eligibility and benefits uh for mental health. Could you please help me?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I sure can look into the benefits and eligibility for mental health. And for my notes, can you spell your first name for me please and provide a good contact number in case we disconnected?
[CUSTOMER][NEUTRAL] Uh sure. [PII].
[CUSTOMER][NEUTRAL] And the callback number is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Mm, yeah, the member policy number is 20, 02502559.
[AGENT][NEUTRAL] 025 02559.
[CUSTOMER][POSITIVE] Yeah, that's right.
[AGENT][NEUTRAL] OK, can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Uh, sure. The first name is [PII] and the last name is um [PII], and uh the date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So I am showing the policy is active, it's been effective since [PII]. And hold on one moment, I'm just looking through the benefits for the mental health policies. Um, do you mind if I place you on just a brief hold?
[CUSTOMER][NEUTRAL] Well.
[CUSTOMER][NEUTRAL] For mental health, uh outpatient. Yeah, I just need uh the benefit for mental health outpatient specialist visit.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I understand. Do you mind if I place you on a brief hold?
[CUSTOMER][NEUTRAL] No. Thank you.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] Oh no, uh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Destination.
[AGENT][NEGATIVE] What hell.
[AGENT][NEUTRAL] So the only thing that would, if they're specialist, it would be this.
[AGENT][NEUTRAL] Alright, well I can choose the desktop options.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][POSITIVE] Yeah, sure, thank you.
[AGENT][POSITIVE] Alright, thank you so much for holding. You're welcome. I apologize for that wait. So looking at the policy um for outpatient, the policy will pay up to $2500 per person per calendar year.
[AGENT][NEUTRAL] That does include um outpatient treatment for a mental or emotional disorder in a hospital outpatient facility with a max of up to 30 days. There's also the specialist office visit fee, um, which will pay up to $50 per visit with a max of 4 visits per calendar year. So depending on the coding, it would probably be one of those two.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK. So just to reconfirm it, uh, you said $50 copay for the office visit?
[AGENT][NEUTRAL] No, not a $50 co-pay. The policy will pay up to $50 per visit towards the visit, um, with a max of 4 days per calendar year for specialist office.
[AGENT][NEUTRAL] So this is their secondary insurance. So they have a primary insurance?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK. So, uh,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So we pay towards the copay, deductible and co-insurance of covered charges after primary.
[AGENT][NEUTRAL] So for their secondary insurance.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So the policy will cover uh after the primary up to $50. Am I right?
[AGENT][NEUTRAL] Correct, if it uses the specialist office visit fee. Once we get the coding, if you all are considered an outpatient facility, it could, it could just come out of that 2500, whatever your um
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Depending on the billing. So it depends on if it comes to us as a specialist office because you mentioned the specialist office, so that's why I gave you that benefit. But if it does come back that it is a hospital outpatient facility, then it could, it wouldn't use that $50 per visit.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So there's 2 different benefits I'm giving you.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] No, no, I just need outpatient office visit.
[AGENT][NEUTRAL] OK, so I'm giving you the 2 because it's, you said for mental health, so there's 2 things that go towards mental health, two benefits. So depending on the coding, if it comes back as a hospital outpatient facility.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Then you don't have to worry about the $50 per visit. Whatever the billing is, it would, it just has that $2500 max. If it does come back, that is a specialist office visit, then that's when we only use the $50 per visit 4 visits per year. So it depends on how it comes to us, both can apply because they're both for mental health.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much, [PII]. That's the information needed for. May I get the call reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then the first initial to.
[CUSTOMER][POSITIVE] Thank you so much. That's the information is uh.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][POSITIVE] Alright, well, thank you so [PII]ch for calling APL. Was there anything else I could assist you with today?
[CUSTOMER][POSITIVE] No, no, that's information you know for uh I'm good for now. Thank you so much.
[AGENT][POSITIVE] You're very welcome and I hope you have a great day.
[CUSTOMER][NEUTRAL] Yeah, you too, bye.
[AGENT][NEUTRAL] Bye bye.