AccountId: 011433970860
ContactId: 94311b45-e77c-4981-b578-7f727db834c5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 302109 ms
Total Talk Time (AGENT): 103293 ms
Total Talk Time (CUSTOMER): 163667 ms
Interruptions: 1
Overall Sentiment: AGENT=1.5, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/94311b45-e77c-4981-b578-7f727db834c5_20250219T16:12_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hi, my name is [PII]. I work for Charleston Dorchester Mental Health Department and we are calling to help a client out and finding out about his coverage. Can you help us with a question?
[AGENT][POSITIVE] Yes, I'll be more than happy to help you with the questions. Um, [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Sure, absolutely. It is [PII].
[AGENT][NEUTRAL] Thank you for that. And the member's policy number?
[CUSTOMER][NEUTRAL] Yes, it is policy number certificate number 02576723.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] He
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes ma'am, [PII], the male [PII] and I have our information tax ID or CI uh MPI number.
[AGENT][NEUTRAL] Alright, and thank you so much for verifying his information and all the information provided is a verification of benefits, not a guarantee of payment. And I am showing the policy is active, it's been effective since [PII].
[CUSTOMER][NEUTRAL] OK, um, he is, um, can I, do you need our MPI or tax identification number to pull us up to see what kind of company we are?
[AGENT][NEUTRAL] Oh no, so this is the, this is the secondary insurance, um, so there's no network or anything.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Oh, secondary insurance. OK, well, what we're trying to find out if he has, we're a mental health facil facility. We're trying to see if he has mental health benefits. And, yes, ma'am. Thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] You're welcome. And again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Is it
[AGENT][NEUTRAL] In hospital or outpatient?
[CUSTOMER][NEUTRAL] Out outpatient, it's like therapy. He comes here for the.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So under outpatient, the policy will pay up to $500 per calendar day for outpatient treatment for a mental or emotional disorder in a hospital outpatient facility.
[AGENT][NEUTRAL] Um, it is maximum to 30 days of treatment per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, so they do he, um, now where we would be out of network. Does he have to go in or he is in or out of network coverage?
[AGENT][NEUTRAL] He's out of you're out of network for his primary insurance?
[CUSTOMER][NEGATIVE] Yes, we're we're not in network with you guys.
[AGENT][NEUTRAL] Well, wait, no, no, no, because that's two different things. So with primary, are you out of network?
[CUSTOMER][NEUTRAL] Um, no, we're in network with his primary. Let's see, with his prime, with his primary, he's got, I don't know who he's got, let's see, he's got, did he have Blue Cross? He has PA Blue Cross Blue Shield, so we're in network with Blue Cross.
[AGENT][NEUTRAL] OK, so we're
[AGENT][NEUTRAL] Right, the reason I'm asking is because we're 2nd to Blue Cross Blue Shield. So if you're in network for Blue Cross Blue Shield, our policy is second to them only. So yes, this, these benefits would apply.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh, good. OK, wonderful.
[CUSTOMER][NEUTRAL] OK, so we can send this in as a secondary form?
[AGENT][NEUTRAL] Right, we will, we will be billed after Blue Cross.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Well y'all would be billed after Blue Cross. OK, wonderful. And then I guess the only other thing, so y'all are so this would be the.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] That's the ID number. Group number is 2614. We're not familiar with you guys. I'm just making sure to put all the information in and then, yeah, yes, and then is there a, and then it's American Public Life, the PO box is on everything's on the back of the card looks like the address and everything so we can just put all that in. yep, I think that's everything we need. So alright, I think we have uh the payer ID um.
[AGENT][NEUTRAL] Oh, sure.
[CUSTOMER][POSITIVE] I think we're good. I appreciate all your help. Thanks so much.
[AGENT][POSITIVE] You're very welcome. Well, was there anything else I could help with [PII]?
[CUSTOMER][POSITIVE] No honey, you're all I'm all set. Thank you again for your help you I hope you have a great rest of your day.
[AGENT][POSITIVE] You also, thanks for calling APL. Bye-bye.
[CUSTOMER][POSITIVE] Thank you, bye bye.