AccountId: 011433970860
ContactId: 9afa15c3-725c-4e7e-8757-071b3b5a0757
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 373269 ms
Total Talk Time (AGENT): 97910 ms
Total Talk Time (CUSTOMER): 191597 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/9afa15c3-725c-4e7e-8757-071b3b5a0757_20250619T16:32_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I was trying to um get some assistance with filing a claim. I'm a therapist trying to file a claim for a uh for a client session.
[AGENT][NEUTRAL] OK, um, do you have the policy number for the patient?
[CUSTOMER][NEUTRAL] Do I have the what?
[AGENT][NEUTRAL] The policy number for the patient?
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Can pull up um.
[CUSTOMER][NEUTRAL] Yes, um, and I was trying to set up something online to do it, um.
[CUSTOMER][NEUTRAL] Am I able to do that, or?
[AGENT][NEUTRAL] And you can, we just have to, you have to have had a claim processed by us first before you can set it up.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Ah, OK, um, because yeah, I was trying to set up an account and they wouldn't let me in. um, OK, so I have his thing.
[CUSTOMER][NEUTRAL] There's a group number.
[CUSTOMER][NEUTRAL] The payer ID.
[AGENT][NEUTRAL] Um, do you see a certificate number or policy cert number?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I have it in oh outpatient benefit certificate number.
[AGENT][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Is that
[AGENT][POSITIVE] Yes, that's correct. That number.
[CUSTOMER][NEUTRAL] OK, OK, it is um 026.
[CUSTOMER][NEUTRAL] 244.
[CUSTOMER][NEUTRAL] 57 M as in Mary, L as in Larry 8.
[AGENT][NEUTRAL] OK. And then can I get your name and a good callback number for our records?
[CUSTOMER][NEUTRAL] Sure. Uh my first name is [PII] My last name is [PII], and phone number is area code [PII].
[AGENT][NEUTRAL] OK, thank you, and [PII]. And then do you have the date of birth for the patient?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, let's see.
[CUSTOMER][NEUTRAL] Mm mm mm.
[CUSTOMER][NEUTRAL] Um, it is.
[CUSTOMER][NEUTRAL] I'm gonna have to look it up.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEGATIVE] Oh, wait too long.
[CUSTOMER][NEUTRAL] OK, hang on, I think I know where to find it.
[AGENT][POSITIVE] OK. Take your time.
[CUSTOMER][NEUTRAL] Have to look
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Hm, oh, there it is, uh, [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, let's see. Uh, I show the policy is effective [PII], it's active. This is a secondary policy, um, so looks like, did he give you a primary insurance as well?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] No, um.
[CUSTOMER][NEUTRAL] A question. Well, he just
[CUSTOMER][NEUTRAL] Huh
[CUSTOMER][NEUTRAL] I guess not. He just started this job, so this is what they
[CUSTOMER][NEUTRAL] Gave him.
[CUSTOMER][NEUTRAL] Um, so, no, that's, that's all I have. Um, so it's a secondary.
[CUSTOMER][NEUTRAL] Insurance. Yeah, I don't, I don't think I have anything else.
[AGENT][NEUTRAL] OK, um, cause this one is secondary. It's like a gap policy. It'll pick up after primary processes the claim, deductible, co-pay or co-insurance. Um, I show his major medical is with United Healthcare.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Oh, OK. I can ask him.
[CUSTOMER][NEUTRAL] I guess he would have to ask his employer about that, so his medical.
[CUSTOMER][NEUTRAL] OK, United Healthcare.
[CUSTOMER][NEUTRAL] Huh, so then this is more, you said like gap coverage?
[AGENT][NEUTRAL] Yes, and so like for example, um, and this is not a guarantee of payment, uh, basic outline of the policy, this pays up to $7000 per calendar year, 100% up to 7000, but it's only going to pay for treatments and procedures rendered in the office, so it won't pay for an actual office visit.
[CUSTOMER][NEUTRAL] Secondary.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] So it does not cover therapy?
[AGENT][NEUTRAL] Yeah, correct. It would, it would pay for outpatient treatment in a mental uh hospital or outpatient facility, um, but it won't pay for just therapy sessions.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh, OK. hmm.
[CUSTOMER][NEUTRAL] OK, well then, I will inform him of all this, and I guess he will have to tell his employer.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK. Well, that
[CUSTOMER][NEUTRAL] That's, I guess what I needed to know, um, so it does not cover. OK.
[CUSTOMER][NEUTRAL] And I will pass all of this on to him.
[AGENT][NEUTRAL] OK, and is there anything else I can help you with?
[CUSTOMER][NEUTRAL] OK, so it covers um.
[CUSTOMER][POSITIVE] No, I appreciate it. I'll just pass it on to him and then see what he wants to do from there.
[AGENT][POSITIVE] OK, sounds good. Thank you for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you. You too. Take care.
[AGENT][NEUTRAL] OK. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.