AccountId: 011433970860
ContactId: b7729758-9589-4bda-8805-fbc9932acc90
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 688969 ms
Total Talk Time (AGENT): 237255 ms
Total Talk Time (CUSTOMER): 383234 ms
Interruptions: 13
Overall Sentiment: AGENT=1.1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/b7729758-9589-4bda-8805-fbc9932acc90_20250324T21:49_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII] um
[CUSTOMER][NEUTRAL] I've worked with a client um who now has.
[CUSTOMER][NEUTRAL] Your
[CUSTOMER][NEUTRAL] Uh, I don't know it's your, your APL, right?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] She sent me this information. Yes, her name is [PII] and um.
[CUSTOMER][NEUTRAL] She did say that this, she, what is it that I have to read her thing again that you are not her primary insurance, but what is the proper phrase for what you are? I'm not used to this. I'm a therapist.
[AGENT][NEUTRAL] Secondary.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Um, let's see, coverage is individual, let's see, plan.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] This is not a major medical plan, yeah.
[CUSTOMER][NEUTRAL] So she's not sure what her benefit is if she's eligible. I'm a mental health counselor, like just mental health counselor in [PII].
[CUSTOMER][NEUTRAL] And um you know I'm, I've never had a situation like this, so I'm not, I didn't really know how to navigate this well, so please excuse me uh so I'm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, it's OK.
[CUSTOMER][NEUTRAL] Yeah, so she, what information would you need from me?
[AGENT][NEUTRAL] OK, are you trying to verify benefits? Are you trying to verify benefits so that she can be seen?
[CUSTOMER][NEUTRAL] I, I have her policy certification.
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] And you're with the facility?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, it's not a facility. It's outpatient mental health counseling.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. What is Ms. [PII]'s policy number?
[CUSTOMER][NEUTRAL] It is 02588448.
[AGENT][NEUTRAL] OK, and what is her date of birth?
[CUSTOMER][NEUTRAL] Uh, no, I don't have that in my hand because I'm seeing I'm just here on my phone with the picture of the back of her card and I guess I'm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Let me see if I can get a chart out.
[AGENT][POSITIVE] Go ahead and take your time.
[CUSTOMER][NEUTRAL] Well.
[CUSTOMER][POSITIVE] Yeah, I've got a, I've, I've got a funny situation. I've been on the phone a lot this afternoon and my phone battery is low, so I've got to bring it over here.
[AGENT][NEUTRAL] Oh no, OK.
[CUSTOMER][POSITIVE] That's OK, it's OK. I got it in time, right, um.
[CUSTOMER][NEUTRAL] Alright, you asked me for her date of birth. It is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, ma'am. Thank you very much for verifying that for me. OK, so I do show that Ms. [PII] does have an active policy. Uh, her effective date is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And this is just to verify her benefits. It's not a guarantee of payment.
[AGENT][POSITIVE] She does have a supplemental insurance policy that's billed secondary to the primary, you're correct on that. And this policy helps with deductible, co-pay, or co-insurance.
[AGENT][NEUTRAL] Uh, she has an inpatient benefit and amount per calendar year of $7150 to help towards deductible copay or co-insurance and then she has an outpatient benefit per calendar day of $500 to help with deductible copay or co-insurance. I'm going to pull her policy up to see if she has outpatient mental health benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] So it's gonna be just a moment while it pulls in.
[CUSTOMER][NEUTRAL] Mm, because most of this is medical.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] It's all medical. So it's billed secondary to our primary major medical insurance.
[CUSTOMER][NEUTRAL] Yes, OK, yeah.
[CUSTOMER][NEUTRAL] Yes, because I'm obviously if it's outpatient, you know, outpatient.
[CUSTOMER][NEUTRAL] Uh, or by day, uh, it's, it's not 500, so you know, um.
[CUSTOMER][NEUTRAL] I mean that wouldn't sound like therapy.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] I'm trying to see if um.
[AGENT][NEUTRAL] So this is the facilities um substance treatment trying to see if there's any.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Let me see if she has office visits, um.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Because I'm not showing.
[AGENT][NEUTRAL] I'm showing that she does have mental health, but it's for um substance abuse treatment facility or a physician's office.
[AGENT][NEUTRAL] Uh, treatment for substance use disorders in a hospital outpatient facility or an outpatient substance abuse treatment facility.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh, it's all substance to be oriented, huh.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] So, are you considered a substance abuse treatment facility?
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] She wasn't sure.
[CUSTOMER][NEUTRAL] No, no, and she, that that's, that would be, um, you know, not true to say she's dealing with any kind of substance abuse at all.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, so she's not dealing with that and that's what her policy covers.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's, it's more, you know, the mental emotional.
[AGENT][NEUTRAL] Right, OK, let me see if it, let me see if the, let me keep reading. See if there's anything for mental.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Emotional.
[AGENT][NEUTRAL] She does have it for treatment in a mental or emotional disorder while confined as an inpatient.
[CUSTOMER][NEUTRAL] Yeah, that's, she's not gonna be confined as an inpatient.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] Yeah, it doesn't look like it helps with outpatient.
[CUSTOMER][POSITIVE] No, she's, yeah, she's working. Mhm, if these are more uh deep end things that this is about, yeah, people who can't manage their lives at all, yeah, I mean, or they're ill, you're right, so they have cancer or something, uh, yeah, and this is, this is why it's supplemental and that makes sense and that's really nice that they have that because.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, right. Yes, ma'am.
[CUSTOMER][NEGATIVE] Those things can be extremely costly for people. Well, um, yeah, so we know, now we know that and I think her, the thing is her own medical insurance has such a ridiculous deductible.
[AGENT][NEUTRAL] Yes ma'am
[CUSTOMER][NEUTRAL] That she's just responsible for the whole thing.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Now, it does state.
[CUSTOMER][POSITIVE] All right well thank you.
[AGENT][NEUTRAL] There is something right here that says other treatment in a physician's office, not including the physician office visit fee.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So treatment in a physician's office, but it doesn't, oh, I see. OK. Yeah.
[CUSTOMER][NEUTRAL] Um, well, I'm not a physician.
[CUSTOMER][NEUTRAL] Right, see, I, I am a licensed mental health counselor, um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You know, and in, in the medical on the other side of the, you know, in the medical, medical, sometimes you have nurse practitioners with specialty in um mental health like things like that, but um, no, this is, this is more the standard, you know, psychotherapist kind of thing.
[AGENT][NEUTRAL] Yes, yes, I understand.
[CUSTOMER][NEUTRAL] Um, yeah.
[AGENT][NEUTRAL] OK. Well, we tried, I tried to find, I tried to dig and see if I can find something for her.
[CUSTOMER][NEUTRAL] That's OK, but you've done a great job and you try, you did, you did.
[CUSTOMER][NEUTRAL] You did, you did. And hey, it is what it is and um I'll work with her. I'll figure something out. I mean, I'm not, I'm not in this to become, you know, a billionaire. I don't want to be one at all because I like a simple life, so I'm OK. And that's why I'm a therapist.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] I do too. And what was your name?
[AGENT][NEUTRAL] What was
[CUSTOMER][NEUTRAL] [PII] oh my name is I go I'm incorporated under [PII] but it's my actual name is [PII] and you know I've got a, got my NPI number. I'm a S corporation. I got my EIN. I've got my, you know, all those sorts of things, my license and and all that stuff, my, so, uh, yeah, so, uh, it is what it is, but, um, you know, um.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] This, this is gonna be OK because I don't charge $500 or anything like that. I work with people with what they can afford and uh I've done that. I worked in a Cambodian refugee camp and I worked. I was a Peace Corps volunteer and things like that, so yeah, yeah, and I like being a therapist, so.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] Oh, how nice.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] I'm here to help people and but I wanna just have fun while I, I make clothing and and I have become quite successful at it so in [PII] so I'm, I'm not worried about like I really can afford to see people if they need it, you know.
[AGENT][POSITIVE] Awesome.
[AGENT][POSITIVE] Yes. Yes, ma'am. That's the biggest thing and we need more people like you that care more about helping somebody than they do about being paid, and that is so nice of you.
[CUSTOMER][NEUTRAL] Yes, and so it it's fine.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yeah, because uh there's nothing really I need or want. I feel like I'm very, very blessed, especially when you work in a refugee camp or you know you've worked with uh disabled children on a mobile clinic or things like that you really feel blessed. I feel extremely blessed and then I and I have my gardening so.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, ma'am. Yes, ma'am. I would feel very blessed too.
[AGENT][POSITIVE] Well, I am so happy that you are, you are blessed. You deserve it.
[CUSTOMER][NEUTRAL] Yes, yes, so you, you're.
[CUSTOMER][POSITIVE] Yeah, yeah, well, thank you. I think you're blessed too because you're very, very nice. You're really very, very nice, and I appreciate, you know, talking to you, so, uh, but thank you for the info, um, I'll break it to her gently.
[AGENT][POSITIVE] Oh, thank you, Ms. [PII].
[AGENT][POSITIVE] OK. All right. Well, you have a good night tonight and thank you for calling APL Ms. [PII].
[CUSTOMER][NEUTRAL] And we'll get by right.
[CUSTOMER][POSITIVE] Thank you, you too. You're welcome. Thank you. Bye bye now.
[AGENT][NEUTRAL] Bye-bye, ma'am.