AccountId: 011433970860
ContactId: 98bca207-978a-4b96-a5ab-b2f64d7079b1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 483049 ms
Total Talk Time (AGENT): 199928 ms
Total Talk Time (CUSTOMER): 216558 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/98bca207-978a-4b96-a5ab-b2f64d7079b1_20250107T21:58_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Good afternoon. Um, I have a current policy with you as a patient and I have a question about, um,
[CUSTOMER][NEUTRAL] An intensive outpatient program that we're enrolled in.
[CUSTOMER][NEUTRAL] I don't know how do I know if it's gonna be covered for an upcoming 12 months, not 12 months, 3 months.
[CUSTOMER][NEUTRAL] Um, program.
[AGENT][NEUTRAL] What type of program is this?
[CUSTOMER][NEUTRAL] It's called IOP. It's an intensive outpatient program at um.
[CUSTOMER][NEUTRAL] At a psychiatric treatment center.
[AGENT][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Um, so I've already received.
[CUSTOMER][NEUTRAL] No, I haven't received any, any bills yet from my, my main insurance, but going into this, I'd like to have some idea of if any of it's gonna be covered or like how do I, how do I know going into this.
[AGENT][NEUTRAL] OK, um, well, I will definitely pull up your policy and then we'll go over the benefits for your policy with APL and and see if there's any um coverage for behavior or mental health. Um, I, I'll see how the policy is broken down, but I can let you know if there's coverage for it.
[CUSTOMER][NEUTRAL] Program.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, and may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Mhm. My name is [PII]. Last name is [PII].
[CUSTOMER][NEUTRAL] Phone number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that. And then may I have your policy number?
[CUSTOMER][NEUTRAL] Um, the outpatient is 2014.
[CUSTOMER][NEUTRAL] 124
[CUSTOMER][NEUTRAL] 7 M like Mary L like Larry.
[CUSTOMER][NEUTRAL] The number 8.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And I think I might have added a number. It was 2014127?
[CUSTOMER][NEUTRAL] Wait, 2014.
[CUSTOMER][NEUTRAL] 1247
[AGENT][NEUTRAL] Oh, wait, so I did have it right. Hold on.
[AGENT][NEUTRAL] Hm, that's too many numbers.
[CUSTOMER][NEUTRAL] That's not the group n that's maybe you want the group number?
[AGENT][NEUTRAL] Yeah, I can try with the group number.
[CUSTOMER][NEUTRAL] 251-69
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] Here we go.
[AGENT][NEUTRAL] 2
[AGENT][NEUTRAL] Oh, the 0 is 0214. OK, I got it.
[AGENT][NEUTRAL] So when you have the 201, just put the 0 in the front, but you really don't need it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I just need you to verify your date of birth, your mailing and email address on file.
[CUSTOMER][NEUTRAL] My date of birth is [PII].
[CUSTOMER][NEUTRAL] [PII]. My address is [PII].
[CUSTOMER][NEUTRAL] And my email address is my [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Alrighty, and thank you so much for verifying your information and all the information provided is a verification of benefits, not a guarantee of payment. Um, so hold on one moment for me. I'm just pulling up your policy documents so I can see the full benefits here, um, and then I'll be able to determine. So is it it's considered outpatient, it'll be?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's called IOP intensive outpatient program.
[AGENT][NEUTRAL] OK. So your policy um for outpatient would pay up to $500 per calendar day.
[AGENT][NEUTRAL] It does include outpatient treatment for a mental or emotional disorder in a hospital outpatient facility.
[AGENT][NEUTRAL] With a max of 30 days per calendar year.
[CUSTOMER][NEUTRAL] Max 30 days.
[CUSTOMER][NEUTRAL] OK, so that should cover it.
[AGENT][NEUTRAL] Mhm. So basically it's going to reset each day, you have a new 500 to use.
[CUSTOMER][POSITIVE] OK, that's a good benefit. Mhm.
[AGENT][NEUTRAL] Huh?
[CUSTOMER][NEUTRAL] Um, OK.
[AGENT][NEUTRAL] Now, if for some reason like if something was to come back like it's in an office, you know, office setting or something, you also have the office treatment rider, so any like treatment as long as it's not cosmetic, um, should be or could be covered up to that 500 per day too. So whether it sounds like it's an outpatient hospital, but just in case because sometimes the coding comes back and it's different.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, well what I'll do is I'll try and get like.
[CUSTOMER][NEUTRAL] Once I get the first invoice or you know.
[CUSTOMER][NEUTRAL] The explanation of benefits from my
[CUSTOMER][NEUTRAL] Primary insurance. I'm gonna call you back and
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Have you review it to see if I'm in the right place before I go, you know.
[AGENT][NEUTRAL] Wait, wait, let me ask you this.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Where you're going, do they have your, like, did you give them your APL insurance card?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The reason I'm asking is because since we're secondary, if you, if you gave them our information, you really shouldn't receive any bills. They're gonna bill your primary first, primary pay and then they automatically bill us. If you get a bill something, then that means that they, they didn't file to us, which, you know, we can handle it once.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] OK, yeah, because I, I, we were already at this facility in the beginning of December and I did get a mail, some paperwork from my, my primary insurance and from APL. It's this is a different service, but.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, from the same.
[CUSTOMER][POSITIVE] This was an inpatient um for treatment. So, I think, I think I'm good.
[AGENT][NEUTRAL] You sure? OK.
[CUSTOMER][POSITIVE] I think we're we're all good, yeah, yeah, I have since I have you on the line, I'll ask you another question. I have some, some other.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Receipts that I wanted to submit. I didn't realize I had such.
[CUSTOMER][POSITIVE] Good benefits with you guys?
[CUSTOMER][NEUTRAL] Um, so I'm, I'm, I'm getting those all together and gonna upload them onto your website. Is there a deadline, um, can you tell me based on when my contract with when my membership started with you guys and how like how far can I go back?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So you literally can go back to when this policy became effective, which was [PII], because we don't have like a timely filing or anything like a deadline. So as long as your policy was active on, you know, whatever data service you're looking at through your records, you can file a claim and this has been active since [PII], so you really can't go back that far.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That's great. OK, excellent.
[CUSTOMER][POSITIVE] All right. Thank you so much for your help.
[AGENT][POSITIVE] You're welcome, [PII]. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Mm nope, that was it.
[AGENT][POSITIVE] Alright, well, thank you so much for calling APL and I hope you have a great day and happy New Year.
[CUSTOMER][POSITIVE] Happy New Year to you. Thanks, bye.
[AGENT][POSITIVE] Thank you, bye bye.