AccountId: 011433970860
ContactId: 7b621c39-f41d-4e1b-bedf-f29bde3d6980
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 278440 ms
Total Talk Time (AGENT): 127673 ms
Total Talk Time (CUSTOMER): 60061 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/7b621c39-f41d-4e1b-bedf-f29bde3d6980_20250327T15:16_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, yes ma'am. I'm needing to see if I can get benefits for mental health substance abuse for outpatient facility.
[AGENT][POSITIVE] Yeah, I'm happy to check on benefits. Uh, let's take a look. Do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, ma'am. It's 1265691.
[AGENT][POSITIVE] Thank you, let me pull this up here one moment.
[AGENT][NEUTRAL] And then if I can get the insured's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], not sure how to pronounce that. Date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Alright, thank you so much. So let me pull the member's policy here. Give me just a second.
[AGENT][NEUTRAL] So the patient plan is active. The effective date if you need that is [PII].
[AGENT][NEUTRAL] This is a verification of benefits, of course, not guarantee of payment. The outpatient benefits it looks like for the calendar year are 4750.
[AGENT][NEUTRAL] And let me look to see if there's anything under the exclusions regarding mental health.
[AGENT][NEUTRAL] So I don't see anything under the exclusions that would lead me to think that uh treatment wouldn't be covered. Um, it just says experimental treatment. So I believe it would, it would fall under their outpatient for the year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, and the 4750, that's the out of pocket max or is that the?
[AGENT][NEUTRAL] Yeah, so that's the um outpatient benefit max because we're the secondary so we're gonna pick up any deductible copay, coinsurance, the primary does not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But this one wouldn't have like any specific copays or anything it's just whatever.
[AGENT][NEUTRAL] Right, it's just picking up what the primary doesn't, so there's no copay on this plan. This is a gap secondary plan to their primary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, well I believe that is everything I needed as far as that um do you have a claims address?
[AGENT][NEUTRAL] Yeah, absolutely. The claims mailing address is going to be uh [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's in [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] And do you have a payer ID?
[AGENT][NEUTRAL] Mhm payer ID is 60801.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh what's the timely filing for these claims?
[AGENT][NEGATIVE] We don't have a timely filing limit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And um could I get your first name and the first initial of your last name?
[AGENT][NEUTRAL] Absolutely. So my first name is [PII], that's [PII] My last initial is [PII], and that is the call reference with today's date. Today's date is [PII].
[CUSTOMER][POSITIVE] Yes ma'am. OK, I definitely appreciate you and thank you for all your help.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Mm bye bye.