AccountId: 011433970860
ContactId: a3aebcd9-7e63-4920-9996-fb5b31c651f1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 465820 ms
Total Talk Time (AGENT): 204262 ms
Total Talk Time (CUSTOMER): 89781 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/13/a3aebcd9-7e63-4920-9996-fb5b31c651f1_20250613T19:10_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] Um, hi, [PII]. This is [PII] in Midland Claims.
[AGENT][NEUTRAL] Hey, how are you doing?
[CUSTOMER][POSITIVE] Good. How are you?
[AGENT][POSITIVE] I'm good.
[CUSTOMER][NEUTRAL] Yeah, it's Friday, huh?
[AGENT][NEUTRAL] It is a whole Friday.
[CUSTOMER][NEUTRAL] Well, I have a provider on the line. She's calling to check on the status of some hospital indemnity claims. Does she need information regarding a provider being in network or not. Would you be able to assist her?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, what's the callback number?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Um, the callback number is [PII] and her name is [PII].
[AGENT][POSITIVE] Thank you and the um
[AGENT][NEUTRAL] Well, she's a provider. Did they give you a policy number?
[CUSTOMER][NEUTRAL] Yes, she gave me the policy number. It is.
[CUSTOMER][NEUTRAL] 02619614 for [PII].
[CUSTOMER][NEGATIVE] [PII].
[AGENT][NEUTRAL] Here we go, OK, uh, you can send her over.
[CUSTOMER][POSITIVE] OK. Here she comes. Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Hi, [PII].
[CUSTOMER][NEUTRAL] Hi.
[AGENT][NEUTRAL] Hi, this is [PII] on the care team. How are you doing?
[CUSTOMER][POSITIVE] I'm doing well. How are you?
[AGENT][POSITIVE] I'm doing good and [PII] was letting me know that you needed to go over um some hospital indemnity claims and to see if you all are in network with us.
[CUSTOMER][POSITIVE] Yes, yes, if we can do that.
[AGENT][NEUTRAL] OK, um, well, the hospital indemnity policy, the part with APL doesn't have a network. It does have the PPL network through multi-plan, um, but that's a different company, so I can't confirm the list. I can give you their phone number or website on for that part of it, um, if you'd like to see if you're in network with multiplan.
[CUSTOMER][NEUTRAL] Um, OK, yeah, what is the?
[CUSTOMER][NEUTRAL] What is the phone number for them?
[AGENT][NEUTRAL] So it's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then for the claims, um, hold on one second.
[AGENT][NEUTRAL] Did you have like the dates of service and the total bills? I don't know, did you need claim status or you just wanted to see if they were received?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Well, they came back to 9, but I'm not understanding exactly what for, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I can give you the first date of service. It's [PII].
[CUSTOMER][NEUTRAL] The build amount was for 250.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Alright, so I'm showing.
[AGENT][NEUTRAL] Um, claim number 3608628 was denied because the charges are not.
[AGENT][NEUTRAL] As the charges are not payable because services were rendered prior to the policy's effective date, OK. So, the effective policy's effective date was [PII], but the date of service is [PII], so the policy wasn't active yet on the date of service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Can you look at the [PII] 1? That was denied as well.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, so for this one, it gave the definition of physician and then it says based on this, um, based on the information provided, the treating provider does not meet the definition of a physician under the policy. Therefore, no benefits are payable.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Would that be something that the multi plan would.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Um,
[AGENT][NEUTRAL] You're saying would, would, what is this? let me see what.
[CUSTOMER][NEUTRAL] Do they need to get like a referral or a prior authorization?
[AGENT][NEUTRAL] No, um, hold on one second. Let me pull this one up and see what that, what the code is.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] hold on one moment.
[CUSTOMER][POSITIVE] No problem thank you.
[AGENT][NEUTRAL] This is the code that was sent over is code [PII].
[AGENT][NEUTRAL] Which is psychotherapy.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So a psychiatrist is different than a physician.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] So this is saying that because it's not like a MD, a medical physician.
[AGENT][NEGATIVE] The policy is not going to cover it.
[CUSTOMER][NEUTRAL] Do they not cover mental health?
[AGENT][NEUTRAL] Let me see. Um, it's a hospital indemnity policy. Most of them don't, but let me double check. Hold on one moment.
[CUSTOMER][NEUTRAL] What kind of policy did you call in?
[AGENT][NEUTRAL] Hospital indemnity. A hospital indemnity policy is a limited medical policy.
[AGENT][NEUTRAL] So it's not a major medical like an Aetna or Blue Cross Blue Shield. It's just a list of services that it'll pay for and how much it'll pay towards it, and then anything outside of it wouldn't be covered.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] But no, ma'am, I don't see any coverage for like for mental health, um, only like the hospital, um, the emergency room, urgent care, the physician's office, um, diagnostic testing, but not like, uh, mental, mental or behavioral health facilities or or benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, I will let the provider know.
[AGENT][NEUTRAL] All right. Well, was there anything else I could assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Um, no, that was all.
[AGENT][POSITIVE] Alright, well, thank you so much for calling APL. I hope you have a great weekend.
[CUSTOMER][POSITIVE] You too. Thank you. Bye-bye.
[AGENT][POSITIVE] You're welcome. Bye bye.