AccountId: 011433970860
ContactId: 9bc18e4a-0663-4b50-b80b-55abe8858325
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 254139 ms
Total Talk Time (AGENT): 148194 ms
Total Talk Time (CUSTOMER): 84543 ms
Interruptions: 3
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/9bc18e4a-0663-4b50-b80b-55abe8858325_20250326T17:07_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] with Laureate Psychiatric Clinic. I'm calling to check um eligibility for patients.
[AGENT][NEUTRAL] Sure, I can check eligibility for you. uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] I do. It is 01874111.
[AGENT][NEUTRAL] OK, thank you. And uh what was the name and date of birth for the patient, please?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that [PII]. So this policy actually terminated, uh, [PII]. If you'll give me one moment, I'll see if they have one that's active. It might just be a different policy number.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, uh, he does have one that is currently active. Uh, let me know when you're ready. I can give you that updated policy number.
[CUSTOMER][POSITIVE] I'm ready.
[AGENT][NEUTRAL] OK, that is 02579323.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 23 OK.
[AGENT][NEUTRAL] Yes, and this one's the effective date just, yes, the effective date just picked up where that other left off, uh, [PII].
[CUSTOMER][NEUTRAL] So he does have an active policy.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, and you show and this is like a secondary policy or supplement policy.
[AGENT][NEUTRAL] Correct. Yeah, this is secondary medical, uh, so it is designed to help with uh co-pay, deductible and co-insurance after major medical pays.
[CUSTOMER][POSITIVE] OK, and it covers um it picks that up on mental health as well.
[CUSTOMER][NEUTRAL] It's not an exclusion or anything.
[AGENT][NEUTRAL] Um, let me check. Mental health is such a broad, it's one of those. Give me just, just a moment. Um, what specifically is this, um, more like a therapy or is this, um, what kind of treatment would he be receiving?
[CUSTOMER][NEUTRAL] I know
[CUSTOMER][NEUTRAL] It's for med it's for mid management.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Bear with me just a moment.
[AGENT][NEUTRAL] OK, uh, and of course I will let you know verification of coverage is not a guarantee of payment for claims. So for this policy, office visits are not going to be covered. Office visits of any kind, so specialists, however, treatment received in office could be. So if you were to receive a treatment in office, that could be covered, correct.
[CUSTOMER][NEUTRAL] So like for therapy.
[AGENT][NEUTRAL] But if it's something, you know, just like a consultation or anything like that then that would not be covered.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] OK, um, I have the actual, um, code for therapy. Could we would that help it to see.
[AGENT][NEUTRAL] I am unable to look up codes like that unfortunately the only way to see those is to file the claims um sorry about that.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Uh, that's OK. OK, so, um, unless it's for how did you put it, um.
[AGENT][NEUTRAL] So office visits of any kind are not covered, so it's it's just like the office visit code which I think it's 99214 um that's not going to be covered but if he receives treatment in office that could be.
[CUSTOMER][NEUTRAL] Treatment
[AGENT][NEUTRAL] Yes, treatment received in office.
[CUSTOMER][NEUTRAL] That's what I, I knew there was a word you said. I was like, what was that you said?
[AGENT][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] So for treatment services then possibly.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] It would be covered. OK, so not just all mental health is excluded just.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, OK, perfect um is there a reference number for this call?
[AGENT][NEUTRAL] It would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII] was there anything else I could help you with, [PII]?
[CUSTOMER][POSITIVE] That was it thank you so much.
[AGENT][POSITIVE] Of course, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you, bye bye.