AccountId: 011433970860
ContactId: 8da98362-e5eb-4532-bb5d-87ac33dc3ac0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 478640 ms
Total Talk Time (AGENT): 168073 ms
Total Talk Time (CUSTOMER): 142101 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/24/8da98362-e5eb-4532-bb5d-87ac33dc3ac0_20250624T12:44_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good morning, [PII]. My name is [PII]. I am calling to verify benefits for mental health, for office visit and telehealth.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But this is uh my first time seeing this plan, so I'm not sure if the practice or my provider is participating.
[AGENT][NEUTRAL] OK, let's take a look at what the patient has. What is the policy number?
[CUSTOMER][NEUTRAL] 02624852
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then for documentation, do you have a good callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. What's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] His name is [PII], [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So, a patient is active. Effective date on here is [PII].
[AGENT][NEUTRAL] So there is no network required for usage with this plan. The type of plan, [PII], is a limited benefit.
[AGENT][NEUTRAL] Hospital indemnity plan.
[AGENT][NEUTRAL] So, it doesn't use the network, it just pays a set amount depending upon what they're being seen or treated for.
[AGENT][NEUTRAL] Um, you said like a physician's office visit, is that one of the things?
[CUSTOMER][NEUTRAL] And no, this is mental health so my provider is a licensed um.
[CUSTOMER][NEUTRAL] Mental health counselor.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So I need to know if an office visit and telehealth and or telehealth visit is covered.
[CUSTOMER][NEUTRAL] I'm sorry, [PII] is a licensed clinical social worker. The provider is Doctor [PII].
[AGENT][NEUTRAL] That's
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK, so it looks like telehealth is on here. It is listed. Um, so the plan would pay $50 towards the visit.
[AGENT][NEUTRAL] And then the patient is allowed up to 4 visits in a year.
[CUSTOMER][NEUTRAL] OK. 4 mental health visits per year? Oh.
[CUSTOMER][NEUTRAL] Well, that's telehealth. Is there anything for a mental health visit? Office visit?
[AGENT][NEUTRAL] So, yeah, it's just an office visit. It doesn't break it down as far as mental health office visit. It's just an office visit with a physician that they're allowed for per calendar year and the plan pays $50 towards it.
[AGENT][NEUTRAL] Because it's not a major medical, it's just a limited benefit plan. So it's only paying that amount towards.
[AGENT][NEUTRAL] Towards that.
[CUSTOMER][NEUTRAL] OK, so the, there's no co-pay or for these 4 visits.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] The client doesn't pay anything but the plan will pay $50.
[AGENT][NEUTRAL] Right. We don't, yeah, we don't have a co-pay or, you know, it's up to the provider or facility to decide what the responsibility of the patient would be.
[CUSTOMER][NEUTRAL] So this plan allows 4 physician visits. It doesn't designate whether it's mental health or a sick visit or it's just 4 visits per year, am I understanding?
[AGENT][NEUTRAL] Yeah, let me make sure I can double check the exclusions to see if I see anything under exclusions.
[AGENT][NEUTRAL] Let me see
[AGENT][NEUTRAL] The only thing I see listed under exclusions is it does list that mental or emotional disorders.
[AGENT][NEUTRAL] But I don't see anything else.
[CUSTOMER][NEUTRAL] The mental or emotional disorders are not covered there.
[CUSTOMER][NEUTRAL] An exception, yeah.
[AGENT][NEUTRAL] It is correct, it is listed under the exclusions, yes.
[CUSTOMER][NEUTRAL] Go ahead
[CUSTOMER][NEUTRAL] Is there any way you could search for CPT code to see if that's covered?
[AGENT][NEUTRAL] Um, no, we don't generally search CPT codes to see if it's covered.
[CUSTOMER][NEUTRAL] Got you. OK, so just so I can explain this to Doctor [PII], this is, it's not a
[CUSTOMER][NEUTRAL] A usual medical plan. It's a limited benefit indemnity plan.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct, yup.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] So I just need to tell him this is not a medical plan.
[AGENT][NEUTRAL] Yeah. And we, I mean, I, we have no idea if they have any other insurance. You would need to check with them if they have something else, you know.
[CUSTOMER][NEGATIVE] Gotcha.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Is there anything else I can check on for you, [PII]?
[CUSTOMER][NEUTRAL] OK. No, [PII], thank you. Can I get a reference number, please?
[AGENT][NEUTRAL] Yeah, absolutely. Call reference is my name with today's date. My name again is [PII], that's [PII] My last initial is [PII], and then today's date.
[CUSTOMER][NEUTRAL] OK, got it, [PII]. Um, and just to verify on the card, um, it says the payer ID is 64556.
[AGENT][POSITIVE] Mhm, yes ma'am, that is correct.
[CUSTOMER][POSITIVE] All right. Very good. Thank you for your time. Have a good day.
[AGENT][NEUTRAL] You as well. Bye-bye.