AccountId: 011433970860
ContactId: 7f47cc1b-e008-4427-ac02-efa89425adc7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 388380 ms
Total Talk Time (AGENT): 189502 ms
Total Talk Time (CUSTOMER): 78107 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/16/7f47cc1b-e008-4427-ac02-efa89425adc7_20250616T16:22_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hi, um, my name is [PII]. I'm calling from a provider's office. I am trying to find out if this client has behavior health benefits.
[AGENT][POSITIVE] OK, I will try to help you, but I'm so sorry I did not catch your name.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] Go ahead and give me a policy number, please, ma'am.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It is 02585497.
[AGENT][POSITIVE] Alrighty, [PII], thank you for that. Now, while I am pulling this up, go ahead and give me a good return telephone call number.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Say that one more time for me.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you so much for all that information. Now, your patient's name and date of birth today, please, ma'am.
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Alrighty, thank you for all that information, [PII]. Looks like [PII] is the insured on this hospital indemnity plan. I do show the original effective date is [PII]. It is current and active, but I must advise that verification of coverage is.
[AGENT][NEUTRAL] I guarantee a payment on the claim, but you did say you want benefits from mental nervous. Is that correct?
[CUSTOMER][NEUTRAL] For behavioral health?
[AGENT][NEUTRAL] Alright, and is that for inpatient, outpatient, office visit? What exact benefit are you needing?
[CUSTOMER][NEUTRAL] It'll be outpatient in an office in [PII] and I'm pretty sure we are out of network uh with this insurance.
[AGENT][NEUTRAL] All right, let me get it pulled up. Let's see.
[AGENT][NEUTRAL] Because what this is is just a hospital indemnity plan.
[AGENT][NEUTRAL] So it just pays based benefits on certain things, so let me get that benefit pad pulled up. Let's see.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] So, um, so basically just outpatient for mental and nervous, correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah, I think let's see, of course, we did not coordinate with anybody else because this is a hospital indemnity plan. Now you said you was not in the uh multi-plan PPO network, correct?
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK. Uh, well, let's see then for office visit.
[AGENT][NEUTRAL] Um, they do have benefits for that, but the um hospital indemnity benefit plan, they have 5 visits payable per calendar year, and we pay a flat fee of $75.
[AGENT][NEUTRAL] Per visit.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Perfect, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That'll be, they're only allowed 5 visits and it's $75 per visit.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, can you let me know the, who do we pay with the payer ID and the address?
[AGENT][NEUTRAL] Uh yes, ma'am, you can uh send that to payer ID 64556.
[AGENT][NEUTRAL] And the address is going to be to [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that is in [PII].
[AGENT][NEUTRAL] And the zip is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and this client, do they have a group number?
[AGENT][NEUTRAL] Oh, let's see if I can get that.
[AGENT][NEUTRAL] Um, hang on just a second. My computer is moving slow, so bear with me. Let's see, number.
[AGENT][NEUTRAL] Oh, I'm not finding a group number. Let me look one other place. Let's see.
[AGENT][NEUTRAL] Alright, group number 70,030.
[CUSTOMER][POSITIVE] OK, perfect. Thank you so much. Um, can I get a reference number?
[AGENT][NEUTRAL] Why is that all, is that all that I can answer for you?
[CUSTOMER][NEUTRAL] It's just
[AGENT][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yes, that's all.
[AGENT][NEUTRAL] Alright, well, we don't give reference numbers, [PII], but you can use my name in today's date and my name is [PII] spelled [PII]
[CUSTOMER][POSITIVE] OK. Thank you.
[AGENT][POSITIVE] All right. Well, yes, ma'am. Thank you for calling APO [PII]. Have a good day.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] You too. Bye.
[AGENT][POSITIVE] Thank you