AccountId: 011433970860
ContactId: 87b87b4a-2ace-4f7d-98e0-32c1298db4b4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 271149 ms
Total Talk Time (AGENT): 134314 ms
Total Talk Time (CUSTOMER): 91355 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/87b87b4a-2ace-4f7d-98e0-32c1298db4b4_20250527T19:37_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] from North Dekalb Primary Care. I was calling to verify.
[CUSTOMER][NEUTRAL] Um, eligibility and copays for a mutual patient.
[AGENT][POSITIVE] OK, Ms. [PII], I can help you with eligibility and benefits for a patient. May I please get your callback number just in case the call's dropped I'll be able to call you right back.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the policy number is 02621615.
[AGENT][NEUTRAL] OK, let me look up that policy real quick for us.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're very welcome.
[AGENT][NEUTRAL] OK, I do show that [PII] does have an active policy. The effective date of her policy is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you're wanting to know about uh pre-authorization?
[CUSTOMER][NEGATIVE] No co-pays.
[AGENT][NEUTRAL] Co-pays, OK. I'm, I'm sorry. Let me.
[CUSTOMER][NEUTRAL] Yeah, what would her co-pay be for um.
[CUSTOMER][NEUTRAL] Uh, primary care physician, uh, who is a.
[CUSTOMER][NEUTRAL] I can't even think nurse practitioner, I'm so sorry.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] It's OK. She has, um.
[CUSTOMER][NEUTRAL] And also what is her mental health co-pay?
[AGENT][NEUTRAL] OK, she doesn't have copays.
[AGENT][NEUTRAL] On this policy, so she has physician office visits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This is a limited benefit hospital indemnity plan.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So she has a physician's office visit. She gets 4 per calendar year that pays, and this is just to verify her benefits. It's not a guarantee of payment. They pay $50.
[CUSTOMER][NEUTRAL] Mhm right.
[AGENT][NEUTRAL] Flat rate $50 for physician's office visit.
[CUSTOMER][NEUTRAL] OK, so the insurance places.
[CUSTOMER][NEUTRAL] Pays $50 flat.
[AGENT][NEUTRAL] Yeah, yes.
[CUSTOMER][NEUTRAL] All right, and what about for mental health um for psychotherapy?
[AGENT][NEUTRAL] Let me see if she has mental health benefits.
[AGENT][NEUTRAL] On her plan
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm gonna need to pull in her policy certificate so it's gonna be just a minute so the computer can load it for us.
[CUSTOMER][NEUTRAL] That's fine. I appreciate your help. I actually work for two different offices and one of them is the mental health facility that she sees, and the other is the primary care. It's kind of strange.
[AGENT][POSITIVE] Oh wow.
[AGENT][POSITIVE] Yeah, but that's all right. That that keeps you busy.
[CUSTOMER][POSITIVE] Oh yeah, I stay busy that's for sure.
[AGENT][NEUTRAL] OK, I'm looking to see. I need to pull up her schedule of benefits to see if mental health is on here.
[AGENT][NEUTRAL] Or if it would be just considered an office visit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so her policy, um.
[AGENT][NEUTRAL] Is written for accident or sickness.
[AGENT][NEUTRAL] And it looks like it would just fall under the office that, yes. Yes, ma'am, for accident or sickness treatment.
[CUSTOMER][NEGATIVE] So she doesn't have mental health benefit.
[CUSTOMER][NEUTRAL] Alright, uh.
[CUSTOMER][POSITIVE] I appreciate your help so much. You have a wonderful day thank you.
[AGENT][POSITIVE] Well, you're very welcome.
[AGENT][POSITIVE] You're welcome. You have a blessed day and thanks for calling APL, Miss [PII].
[CUSTOMER][POSITIVE] All right thank you bye bye.