AccountId: 011433970860
ContactId: 91f112d4-dcd0-4889-810a-7019ff5d5d18
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 504589 ms
Total Talk Time (AGENT): 159028 ms
Total Talk Time (CUSTOMER): 105856 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/91f112d4-dcd0-4889-810a-7019ff5d5d18_20250404T15:27_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hey, my name is [PII] and I'm calling from the office of [PII]. I'm calling because I wanted to verify the provider's network status with this policy, and then I wanted to get the benefit for outpatient mental health rendered in the office, please.
[AGENT][NEUTRAL] OK, thank you. And may I have a callback number just in case we get disconnected, Mr. [PII]?
[CUSTOMER][NEUTRAL] Yep it's [PII].
[AGENT][POSITIVE] Thank you. And sure, I can assist you with networking benefit information. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] Uh, policy number is 261-1351.
[AGENT][NEUTRAL] OK. May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] and it's [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] All right, um, Mr. [PII], this particular policy is one of our limited hospital indemnity policy, which is a limited policy, and there's no network under this one. and you said for mental health, is she gonna be seeing a psychiatrist or is it gonna be a psychologist? What type of doctor?
[CUSTOMER][NEUTRAL] Um, the doctor is, um.
[CUSTOMER][NEUTRAL] It's an MD which she specializes in a mental health.
[CUSTOMER][NEUTRAL] So yeah it will be for therapy services.
[AGENT][NEUTRAL] OK. So for therapy services and but this is not a psychiatrist, correct?
[CUSTOMER][NEUTRAL] Uh, yes, um, and she'll be seen in the office.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, bear with me just a second. Let me go ahead and pull her benefits. Do you mind holding for me?
[CUSTOMER][POSITIVE] Oh no problem, sounds great.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Impatient for me. OK, Mr. [PII]. So this particular policy, um, it will only cover if it's a psychiatrist and it will be under the office visit benefit, um, which is $50 per visit, maximum of 4 visits per covered person per calendar year.
[AGENT][NEUTRAL] And this is not a guarantee of payment, just a verification of coverage.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Got you. OK, so just to clarify, they have $50 copay and they have a max of 4 visits uh to use per year, is that correct?
[AGENT][NEUTRAL] Um, it is not a copay, that is a flat amount that we cover.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] So, but that is the patient's patient's responsibility though.
[AGENT][NEUTRAL] No, we pay 150, so they're responsible for anything after the 150.
[CUSTOMER][NEUTRAL] Oh, got you, so you guys pay 50.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, mhm.
[CUSTOMER][NEUTRAL] And they'll be responsible for the fee afterwards. Now were you showing the providers um as in network or out of network?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] There's no network on this one.
[CUSTOMER][NEUTRAL] Oh no network, OK.
[AGENT][NEUTRAL] And they can choose where to go. Mhm, yeah.
[CUSTOMER][NEUTRAL] Got you, um, and now do you have the effective date of the policy?
[AGENT][NEUTRAL] Yes, let me get that for you. All right, we have an effective date of, let's see, [PII].
[CUSTOMER][NEUTRAL] Great, OK, and then also do you show telehealth as being a covered service on the policy?
[AGENT][NEUTRAL] That's part of that office visit benefit.
[CUSTOMER][NEUTRAL] It's OK, so we covered the same, got you.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK and then um do you mind if I get the claims mailing address and uh the electronic payer ID if you have that?
[AGENT][NEUTRAL] OK, let me see exactly who the zip code to. Bear with me.
[AGENT][NEUTRAL] OK, so they want this one goes to IMA first, so it will go to IMA and that is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um-hum.
[AGENT][NEUTRAL] The payer ID is 64556.
[CUSTOMER][POSITIVE] Perfect. OK.
[CUSTOMER][NEUTRAL] And then um I think my last question is are you showing um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] to be the policy holder?
[AGENT][NEUTRAL] Yes, mhm.
[CUSTOMER][POSITIVE] She is OK wonderful.
[AGENT][POSITIVE] Yes yes.
[CUSTOMER][NEUTRAL] All right, um, I think that might be everything I need and do you mind if I just get a reference number for the call and then it should be set?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Um, we don't have reference numbers. You can use my name in today's date if you will. Do you need the spelling of my name?
[CUSTOMER][POSITIVE] Sure that'd be great.
[AGENT][NEUTRAL] OK, that's [PII].
[CUSTOMER][POSITIVE] Awesome well I appreciate you and thank you for all your help and I hope you have a great day and a good weekend.
[AGENT][POSITIVE] You're welcome. You as well. Thank you for calling APR. Have a good weekend, Mr. [PII]. Goodbye.
[CUSTOMER][POSITIVE] Yeah take care bye.
[AGENT][POSITIVE] Thank you you too.