AccountId: 011433970860
ContactId: 95ee1b0c-f70f-4736-82ac-68d61f4fc7c5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 205789 ms
Total Talk Time (AGENT): 76941 ms
Total Talk Time (CUSTOMER): 102259 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/02/95ee1b0c-f70f-4736-82ac-68d61f4fc7c5_20250602T18:25_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, [PII]. My name is [PII]. We currently have a plan and I wanted to inquire if some upcoming therapy we're looking at could potentially be covered.
[AGENT][POSITIVE] I sure, [PII], I can assist you with your benefits. Um first, can I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. Thank you. Now, could I get your policy number, please?
[CUSTOMER][NEUTRAL] The policy number?
[CUSTOMER][NEUTRAL] I, well, there's the group number, there's the payer ID, and then there's the in hospitals and the outpatient numbers which one do you need?
[AGENT][NEUTRAL] Um, the outpatient number is your policy number.
[CUSTOMER][NEUTRAL] OK, so the outpatient benefit number is 02424886ML8.
[AGENT][NEUTRAL] OK, thank you. And please verify your name again and your date of birth.
[CUSTOMER][NEUTRAL] I am [PII]. My birth date is [PII]. 0, I'm sorry, I'm sorry. I was giving you my son's. Um, my birthday is [PII].
[AGENT][NEUTRAL] OK. And thank you and please verify your mailing address.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. Thank you. And the services um you're inquiring, um, where will they take place? Will they take place in an outpatient facility or in an office?
[CUSTOMER][NEUTRAL] A therapy office.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Specifically ABA.
[AGENT][NEUTRAL] OK. Yes, ma'am. I'm showing that therapy is covered in office, um, but for services provided in office, we cover up to 6000 per calendar year for the coinsurance and the deductible after the primary insurance processes the claim, but the co-pay for any office visits is not covered.
[CUSTOMER][NEUTRAL] OK, so this particular ABA office let me know that United Healthcare is not something they accept. So if it's an office that doesn't accept our insurance, how does that work?
[AGENT][NEUTRAL] OK, yeah. If it's not a service is not covered by your primary carrier, regardless of who the primary carrier is, we don't cover it at all as the secondary carrier because we go by the primary carrier's guidelines.
[CUSTOMER][NEUTRAL] OK, got it. Well, um, uh, you know, I'll keep looking. It, it is much more difficult than I thought it was gonna be to find therapy for a [PII] who is afraid of potties. So I'll, I'll keep seeing if I can find somebody who's maybe in network.
[AGENT][POSITIVE] Oh wow.
[AGENT][NEUTRAL] OK. I'm sorry, [PII]. Is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][POSITIVE] No, I'll, I'll keep going, but I always appreciate the, the calls when I call or the, the information, so thank you.
[AGENT][POSITIVE] Mhm. Well, thank you for calling ATL. You have a great rest of your day. Mm bye.
[CUSTOMER][NEUTRAL] You too bye.