AccountId: 011433970860
ContactId: 8477875d-e7e0-439f-b31d-992f8063db96
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 561320 ms
Total Talk Time (AGENT): 181682 ms
Total Talk Time (CUSTOMER): 317361 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/8477875d-e7e0-439f-b31d-992f8063db96_20250520T20:39_UTC.wav
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[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello.
[AGENT][POSITIVE] Thank you for contacting AT. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. I'm calling you from Manage mental health. We are a mental health office, mental health providers. I'm calling because um one of our patients is reporting this, um, insurance, I mean, they have this insurance coverage that it's supposed to cover what is not covered by the principal insurance.
[CUSTOMER][NEUTRAL] So I'm just calling because I need to kind of verify all this information and check the benefits and see how you guys works in order to um to build the services that are not covered by the primary insurance.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hello, I'm sorry. I wasn't, my phone is cutting in and out. I wasn't able to hear you. Um.
[AGENT][NEUTRAL] I'm sorry, can you hear me now?
[CUSTOMER][NEGATIVE] I, I can't hear, I, not so well. It kind of feels um far away.
[CUSTOMER][NEUTRAL] I can't hear you well.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, I'm sorry. I'm not able to hear you very well. Um, did you, uh, would you like to look at, is there something I can look at about one of your policies or, um, is there a policy number that you have for me that I can look up?
[CUSTOMER][NEUTRAL] Yes, I have a policy number.
[AGENT][NEUTRAL] And what is that please?
[CUSTOMER][NEUTRAL] It's 02497462 M as in Mary, L as in Louis, number 8.
[AGENT][NEUTRAL] Thank you. If I could just verify your um name, date of birth and the phone number, please?
[CUSTOMER][NEUTRAL] Yeah, the patient's name.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Uh, date of birth, it's [PII].
[CUSTOMER][NEUTRAL] And uh you need telephone number of the office or telephone number of the patient?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, no, I need your phone number, please, in case we're disconnected.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you, and I'm, I'm sorry that, as I said, I'm having trouble with my phone. I didn't catch your name.
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] OK, well, thank you. The policy went into effect on [PII]. It is active. But this is a secondary or gap insurance and it is meant to pick up the deductible, co-payment or co-insurance from her major medical.
[AGENT][NEUTRAL] Um, now that there are both in and out of hospital benefits as well as treatment within the physician's office, um, cancer treatment, that sort of thing. Is there anything in particular that I can tell you about the policy?
[CUSTOMER][NEUTRAL] Yeah, basically, I mean it's the first time that we are working with this kind of policy. I know that it's a secondary coverage patients have another insurance, but with that insurance I already checked the benefits and she's supposed to have some kind of co-payments every time she comes.
[CUSTOMER][NEUTRAL] To the office, so I just wanna know how does it work to send those, I mean responsibility that the patient is supposed to have with the primary insurance? How do I supposed to bill it here or it go directly from the primary insurance billing?
[AGENT][NEUTRAL] But no, you would, you would file through their major medical first.
[AGENT][NEUTRAL] And then you would file through us and for the office visit.
[AGENT][NEUTRAL] What we will do is we will pick up the deductible, co-payment or co-insurance up to $50. Um, she has 4 of those visits, of course, that's just a verification of benefits, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How do
[CUSTOMER][NEUTRAL] Yeah, I'm, I'm so sorry. I, I'm, I'm not able to hear you well. It's the, I mean the call feels kind of far away, um.
[CUSTOMER][NEUTRAL] Can you try to explain to me a little um.
[AGENT][NEUTRAL] Yes, uh, yeah, so what we'll do is, um, for the office visits, you would file through their major medical first.
[AGENT][NEUTRAL] And then you would file through us.
[CUSTOMER][NEUTRAL] We file to us or the insurance will?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] But you you would file through the major medical and then uh.
[CUSTOMER][NEUTRAL] OK, so I have to file both the ones for the medical and I mean the main insurance, and then I have to file to, to you guys.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] That's right, yes, that's what you would do.
[CUSTOMER][NEUTRAL] OK, do I file, uh, I mean, it's there any specific claim form that I need to fill any portal that I can send it? How does it work?
[AGENT][NEUTRAL] Yes, you can go through, um, our we do have a an online service center.
[AGENT][NEUTRAL] At [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you can go on that, um, or you can mail a HIPA 1500 form to us, uh, a regular claim form.
[CUSTOMER][NEUTRAL] Do I have to create an account there?
[AGENT][NEUTRAL] Uh, with us, yes. If you do it online, then yes, you'd have to create an account. It just takes a few moments. All it is is that you're, you're just putting the, the insured, um, information in and then you're just creating a password.
[CUSTOMER][NEUTRAL] Do I have to create an account there?
[CUSTOMER][NEUTRAL] OK, now any provider, do I have to be on file with you like half an hour with you or any provider works for you?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Any, any pro any provider can do it.
[CUSTOMER][NEUTRAL] OK, now when I'm filing that information, I mean to the insurance, I have to file like the general claim that of course the insurance is gonna it's gonna pay for a portion of those. I think that patient is gonna have a co-payment of around $60. I have to file, I mean I have to bill that specific responsibility only, right?
[AGENT][NEUTRAL] Right, and what we will do is we will pay $50 for for 4 visits and, and as I said before, it's just a verification of that's not a guarantee of payment, but that's what we do is we, we have 4 of them.
[CUSTOMER][NEUTRAL] So you
[CUSTOMER][NEUTRAL] You only pay the same. It doesn't matter what is the responsibility with the insurance or anything.
[AGENT][POSITIVE] Right, that's correct.
[CUSTOMER][NEUTRAL] It's 550.
[AGENT][NEUTRAL] No, no, it's 50, 50.
[CUSTOMER][NEUTRAL] $550.50 dollars. OK, so the difference, it's supposed to be responsibility of the of the patient.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, because it's still, I mean, the for the through the medical insurance through the health plan, it's supposed to have a $60 co-payment if you guys pay $50 then the 10, it's there have responsibility.
[AGENT][NEUTRAL] Right, it's
[CUSTOMER][NEUTRAL] It's that how it works?
[AGENT][NEUTRAL] Yes, yeah, anything above that would be, would be something that, that is between you and me.
[CUSTOMER][NEUTRAL] OK, so to file to you guys, do I have to wait for the insurance response for the main insurance response or I can file it at the same time that I'm filing the insurance? I have to wait for the response.
[AGENT][POSITIVE] Yes, yes, you do.
[AGENT][NEUTRAL] No, you would have
[AGENT][NEUTRAL] Right, that's true.
[CUSTOMER][NEUTRAL] OK, and the last question that I have.
[CUSTOMER][NEUTRAL] Uh, let me see.
[CUSTOMER][NEUTRAL] OK. How many visits do you cover?
[AGENT][NEUTRAL] 4
[CUSTOMER][NEUTRAL] Only 4 visits a year.
[AGENT][POSITIVE] 4 business a year, that's correct.
[CUSTOMER][NEUTRAL] OK. What about if the patient, it's gonna need more than 4 visits?
[AGENT][NEUTRAL] Uh, well then, then that would be, yeah, uh-huh.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] That's that would be the patient responsibility then.
[AGENT][POSITIVE] Right, that's, that's correct.
[CUSTOMER][NEUTRAL] OK, OK. In my case, we are a mental health offices, so it's probably the patient is gonna have the first evaluation, which is psychotherapy. It's, I mean, it's part of those services that you guys cover with those $50 psychotherapy services.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, and it's it's applied, yeah, I mean, I'm gonna go in the in in the portal that you gave me. I'm gonna try to create that account. Is there any CPT code that I need to report it looks similar to a regular claim form.
[AGENT][NEUTRAL] It's, it's just a regular claim form. That's correct.
[CUSTOMER][NEUTRAL] OK. It's a 1500?
[AGENT][POSITIVE] Yeah, it's the 1500. That is correct.
[CUSTOMER][NEUTRAL] OK, perfect. Now, in the amount that I'm gonna bill in that information, I think I got to be I asked you before, but I don't have that information clear. Do I have to put any specific amount or just the $50?
[AGENT][NEUTRAL] Uh, just let us know what the charge is, and then, and then we will, we will pay with the, with the policy up to the, the amount the policy will pay.
[CUSTOMER][NEUTRAL] OK, OK, so I'm, I'm supposed to put in there the difference that the insurance is not gonna cover.
[AGENT][NEUTRAL] Right.
[CUSTOMER][POSITIVE] OK, OK, sounds good. OK, perfect. Thank you so much for your help. I'm gonna start creating that account there and in case that I have any questions I will call you back. I thank you so much for the help.
[AGENT][POSITIVE] OK, [PII], thank you very much for contacting AP have a good day.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] You too bye.