AccountId: 011433970860
ContactId: b58988c7-ca62-467d-92e1-399eca29e4eb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 235080 ms
Total Talk Time (AGENT): 126392 ms
Total Talk Time (CUSTOMER): 89189 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/b58988c7-ca62-467d-92e1-399eca29e4eb_20250131T14:22_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How can I help you?
[CUSTOMER][NEUTRAL] Hey, [PII]. I have a provider on the phone that wants mental health and psychotherapy benefits on HI.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, and I'm not sure.
[CUSTOMER][NEUTRAL] What that is for mental health on the HR.
[AGENT][NEUTRAL] OK, can I have the policy number please?
[CUSTOMER][NEUTRAL] It is 02550402.
[CUSTOMER][NEUTRAL] Her name is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Her phone number is [PII].
[AGENT][NEUTRAL] OK, and is the patient uh information been verified?
[CUSTOMER][NEUTRAL] Yes, mhm, yeah, I always verify everything before I even talk to them.
[AGENT][NEUTRAL] And it looks like it's for.
[AGENT][NEUTRAL] Uh, wait, I must have the wrong number 0250402 sorry.
[CUSTOMER][NEUTRAL] On [PII]. Yeah, it is too early. I've already had 3 calls already this morning, so they got me going.
[AGENT][NEUTRAL] It's early. [PII] got it.
[AGENT][NEUTRAL] Yeah, I hear that. OK.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] All right, you're so welcome. Have a great day.
[CUSTOMER][NEUTRAL] Mhm. Bye-bye. You too. Bye-bye.
[AGENT][POSITIVE] Thank you, bye.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] I love explaining this one.
[AGENT][NEUTRAL] Hi, is this [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Hi, [PII]. My name is [PII].
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Hey [PII], how are you?
[AGENT][POSITIVE] I'm doing well thank you how are you?
[CUSTOMER][POSITIVE] I'm doing great.
[AGENT][NEUTRAL] So you needed some uh benefits for uh Mr. [PII] for uh I believe mental health. Is that correct?
[CUSTOMER][POSITIVE] Yeah, yes, ma'am, and I do, if you need CPT codes, I can give you a couple too if that helps at all.
[AGENT][NEUTRAL] Let me just get into his policy here and bear with me for just one moment and just to let you know it is a verification of coverage only and not a guarantee of payment and this is is this outpatient?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes ma'am it is.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Just give me one moment.
[CUSTOMER][POSITIVE] Yes ma'am, you're welcome.
[AGENT][NEUTRAL] So, um, this policy is a limited medical hospital indemnity plan. Um, so it does have limited medical benefits, and under this plan for, uh, Mr. [PII], it looks like it is hospital admission and confinement. He does have accident and sickness surgery benefit as well as a diagnostic testing benefit. So this policy is more surgery focused, so it doesn't have any outpatient benefits for um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] A physician, uh, encounter or even, um, unless it's a, a hospital admission, um, then it, it, it wouldn't be eligible.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK and so pretty much, um, long story short of it, he just doesn't have like mental health coverage whenever it's considered to be like outpatient but inpatient possibly but we're not doing that with him.
[AGENT][NEUTRAL] Yes, unfortunately, and like I said, this policy does also have uh a surgery benefit and a diagnostic testing benefit, but that's um the only thing it covers for um any, any kind of outpatient service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, ma'am.
[CUSTOMER][POSITIVE] Sure, that's no problem at all. Can I get a call reference number?
[AGENT][NEUTRAL] Certainly the call reference number you'd use my name in today's date. My first name [PII]
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Last initial [PII] and then today's date.
[AGENT][NEUTRAL] Did you have any other questions, [PII]?
[CUSTOMER][POSITIVE] All right, thank you.
[CUSTOMER][POSITIVE] No ma'am, that was all thank you so much for your help I greatly appreciate it.
[AGENT][POSITIVE] You're so welcome. Thank you for calling API. I hope you have a great rest of your day and a great weekend.
[CUSTOMER][POSITIVE] Thank you. You as well.
[AGENT][POSITIVE] Thank you bye bye.
[CUSTOMER][NEUTRAL] Bye.