AccountId: 011433970860
ContactId: bb1cd724-9436-40cc-9a0e-67faf3575cc2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 805049 ms
Total Talk Time (AGENT): 283529 ms
Total Talk Time (CUSTOMER): 459873 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/bb1cd724-9436-40cc-9a0e-67faf3575cc2_20250204T16:46_UTC.wav
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[AGENT][NEUTRAL] APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, um, I'm a, um, medical provider, and I just wanted to check on what benefits that you guys provide to my client, so I didn't know you.
[AGENT][NEUTRAL] OK, are your provider's office or outpatient facility?
[CUSTOMER][NEUTRAL] I say it again.
[AGENT][NEUTRAL] Are you calling from a doctor's office or an outpatient facility?
[CUSTOMER][NEUTRAL] No, I'm in um outpatient uh mental health facility, yeah.
[AGENT][NEUTRAL] OK, and what's your name?
[CUSTOMER][NEUTRAL] Yeah, my name is [PII]
[AGENT][NEUTRAL] And [PII], what's the policy number?
[CUSTOMER][NEUTRAL] Ok, give it to you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, it is, um.
[CUSTOMER][NEUTRAL] 02584565
[AGENT][POSITIVE] And a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] The [PII].
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, [PII]
[CUSTOMER][NEUTRAL] And the date of birth is um.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] Alright, thanks for that information, [PII], and what type of service is it for?
[CUSTOMER][NEUTRAL] Um, for outpatient mental health.
[AGENT][NEUTRAL] And what's the chief complaint?
[CUSTOMER][NEUTRAL] Oh, you know, anxiety, um, stress, that kind of thing, yeah.
[AGENT][NEUTRAL] OK, so the policy number that you gave me is for an accident policy. So are you wanting the medical policy number?
[CUSTOMER][NEUTRAL] OK, so my question is, so the, the number I gave, so the benefit that he has doesn't cover outpatient mental health, right?
[AGENT][NEUTRAL] You know, I'm saying the policy number that you gave me is for the accident policy, which it wouldn't be covered under that because it's not an accident. So I'm gonna give you the policy number for the medical plan. It's a different number.
[CUSTOMER][NEUTRAL] Right, right.
[CUSTOMER][NEUTRAL] Well, no, but I that that's the only card he gave me was the number I gave you.
[AGENT][NEUTRAL] I know it. So I'm giving you the correct number, policy number. Let me know when you're ready.
[CUSTOMER][NEUTRAL] Oh, there's another, another policy number, uh.
[CUSTOMER][NEUTRAL] OK, what's that?
[AGENT][NEUTRAL] OK, so it's 258.
[CUSTOMER][NEUTRAL] 258
[AGENT][NEUTRAL] 45.
[CUSTOMER][NEUTRAL] 45
[AGENT][NEUTRAL] 64.
[CUSTOMER][NEUTRAL] 64
[AGENT][NEUTRAL] And this is the medical policy.
[AGENT][NEUTRAL] And I'm showing the
[CUSTOMER][NEUTRAL] So he's got 2
[AGENT][NEUTRAL] Yeah, the other one is an accident policy, which is the one that you gave me.
[CUSTOMER][NEUTRAL] Alright, so you
[CUSTOMER][NEUTRAL] OK, that's why I'm asking because he just gave me the card, um, with the accident policy but you're saying he has to.
[AGENT][NEUTRAL] Yeah, I know.
[CUSTOMER][NEUTRAL] Yeah, OK
[AGENT][NEUTRAL] Yeah, I'm just letting you know that he has a medical policy as well, and I gave you the policy number for the medical policy.
[CUSTOMER][NEUTRAL] Oh, so
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Oh, OK, so he does that. He didn't tell me that. That's why I'm uh clarifying, yeah, so he has two policies an accident and a medical.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEGATIVE] Right under under you guys American Public Life.
[AGENT][NEUTRAL] I mean, he has more than 2, but you're only interested in the medical policy. So did you want the benefit for that? If so, we can proceed?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Yeah, that would be great, yeah, good, yeah.
[AGENT][NEUTRAL] OK. All right.
[AGENT][NEUTRAL] And what is the patient's date of birth?
[CUSTOMER][NEUTRAL] OK, um, it's [PII].
[AGENT][NEUTRAL] Thank you for that. So this policy became effective [PII]. It is active.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And now, outpatient facility is not covered under this policy. So is it a mental health facility or a hospital?
[CUSTOMER][NEUTRAL] OK, well, I don't know, I'm, I'm a mental health outpatient mental health provider, so I don't know what, but that would, that would fall under, yeah.
[AGENT][NEUTRAL] What's the name? What's the name of the hospital?
[CUSTOMER][NEUTRAL] OK, it's not a hospital. I'm a private practice, so.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] I'm in private practice, so it's not a hospital.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so the service is in a physician's office, specialist office?
[CUSTOMER][NEUTRAL] Yeah, uh, yeah, private, it's a private practice mental health, so, uh, yeah.
[AGENT][NEUTRAL] OK, yeah, I'm just trying to determine the place of service before I provide the benefit.
[CUSTOMER][NEUTRAL] Yeah, that's fine, yeah.
[AGENT][NEUTRAL] OK, so it's in the office?
[CUSTOMER][NEUTRAL] Yes, yes, office is, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so under his policy for an office visit, the benefit is up to $75.
[AGENT][NEUTRAL] And that's per visit?
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] And then
[CUSTOMER][NEUTRAL] So that's an outpatient mental health visit or that's any visit uh for him? I mean a doctor.
[AGENT][NEUTRAL] Yeah, just any visit in a doctor's office.
[CUSTOMER][NEUTRAL] Oh, OK, so mental health or physician or anything, yeah, you're saying any medical provider visit.
[CUSTOMER][POSITIVE] It's $75. OK, perfect, yeah.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Up to $75 per visit.
[AGENT][NEUTRAL] A maximum of 5 visits.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Her calendar year.
[CUSTOMER][NEUTRAL] OK, maximum of 5 visits then, yeah.
[AGENT][NEUTRAL] And then I do not show he's used any of the visits for [PII].
[AGENT][NEUTRAL] So those, the 5 are availab[PII] and any information for.
[CUSTOMER][NEUTRAL] Right, yeah, OK.
[CUSTOMER][NEUTRAL] So how
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Go ahead, yeah.
[AGENT][NEUTRAL] Yeah, so the 5 visits is not just for the mental health visits, it's collectively, any, any office visit for any reason, the maximum per year is 5.
[CUSTOMER][NEUTRAL] What you say, go on.
[CUSTOMER][NEUTRAL] Vibe I get it yeah OK and now how, um how do I submit this because I, he has, he has a primary insurance, right? So, um, this is a secondary right? but he can still, so I can submit I would just submit a claim to you guys is that how this would work.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Correct, along with the EOB if he's stating that he has a primary.
[CUSTOMER][NEUTRAL] OK, so, oh, OK, so on the um.
[CUSTOMER][NEUTRAL] So the claim would be um so on the claim I have to indicate what that that that there is a primary insurance.
[CUSTOMER][NEUTRAL] Huh, on the, um, on the claim I have to say there's a primary insurance, right?
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] You don't necessarily have to indicate it on the claim, just send us a copy of the primary E because you'll send it to the primary first, wouldn't you?
[CUSTOMER][NEUTRAL] Right, yeah, we send it to the primary and then they would, they probably he's got a high deductible, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, so they would, they would apply to the deductible so then what do I do?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So then you would send the CMS 1500 form, the itemized bill, and a copy of the primary explanation of benefits to APL.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Oh, OK, so you want the OB from the primary insurance and then you want um and then do a CMS too.
[AGENT][POSITIVE] Correct, and, and that comes to APL, yes.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] I get it. And do, do you have a payer ID?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, the payer ID number?
[AGENT][NEUTRAL] It's 645-56.
[CUSTOMER][NEUTRAL] 64556 you said?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, 645-56 payer ID and then the address.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um, I just wanna make sure.
[AGENT][NEUTRAL] The
[CUSTOMER][NEUTRAL] Hold on, let me get, um, is uh [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Yeah, OK, I see the payer ID on the back of this card, but the, so the payer ID is the same even though this card just indicates, um, accident, yeah, it's so everything else is the same, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, he actually has a uh ID card for his medical policy as well. He may have just given you the incorrect one.
[CUSTOMER][NEUTRAL] Oh, I get it. Oh, they're kind of they were they look like the same because they look like the same card.
[AGENT][NEUTRAL] They are the same, but it'll just state the type of policy, so his, his, his medical policy will state a medical policy and not accident.
[AGENT][NEUTRAL] I mean his ID card.
[CUSTOMER][NEUTRAL] Oh, I, I get, yeah, because here on the, um, it says, uh, um, it says on the front limited benefit hospital indemnity. So under, under the, under the other card where you gave me the number, it would indicate um what medical plan or something, what would be the wording.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Or accident policy or something like that. And, and actually, he probably does not have a, an, uh, policy, uh, ID card for the group accident.
[AGENT][NEUTRAL] So the card that you have, it says hospital indemnity.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And what's the policy number on the card?
[CUSTOMER][NEUTRAL] Um, it's, um.
[CUSTOMER][NEUTRAL] Oh yeah, you just, yeah, you just gave me, you gave me it's the same number, the policy number is the same.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And the one you gave me was
[CUSTOMER][NEGATIVE] It is limited benefits.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Limited benefit hospital Idemnity is on on this card.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Right.
[CUSTOMER][POSITIVE] So this is the right card you gave me the right card then, right? Yeah.
[AGENT][MIXED] Correct, but you gave me a different policy number initially, ending in a 5 instead of a 4.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh, OK let me see, um, um, that's right, yeah, I don't know. Yeah, I don't, yeah, I don't, I don't know why I did that. I'm sorry, so it's 0, yeah, I have 02, no, I have, yeah, I have 025. You're right, it is a different number except for the it's 025 instead of 02.
[CUSTOMER][NEUTRAL] 025 025802584564. So I I don't know, I, I give you, I, I, I'm sorry, but that's the right number that is the medical policy number, yeah.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Correct. And what's, what's the name of, what's the name of the practice, [PII]?
[CUSTOMER][NEUTRAL] Is that, yeah, OK.
[CUSTOMER][NEUTRAL] Yeah, my name is [PII] finding strength counseling, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All righty. Do you have any other questions?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No, OK, so, so the, um, uh, yeah, so that's it, so I use it so that, um.
[CUSTOMER][NEUTRAL] Oh, I, oh, hold on, hold on, so you're saying the, the number, the, the correct number I put in [PII], but that's not I have the [PII], right?
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] Yeah, the 2564, I mean the 4564 is for the medical policy. The 4565 is the accident policy, so I don't know where you got the, yeah.
[CUSTOMER][NEUTRAL] Oh, I get it, OK.
[CUSTOMER][NEUTRAL] Yeah, alright, so, but the number you have to use the 0 yeah 025, yeah, um, 84564. That's the, that's the medical policy then there's an accident one which is the exact same number except there's a 5 at the end instead of a 4.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Oh perfect. OK, alright, so that's good. So I'll, so I, I would, um, just do that. I would, so I have to wait until his primary insurance processes the claim and then I would say I would, yeah, yeah, OK, and is there a fax? I don't know if there a fax, uh, because I don't, I guess I.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] No, there's not a, there's not a fax number.
[CUSTOMER][NEUTRAL] So, so I don't know how I would send you the ELB that's what I'm asking you, um, how I would send that to you.
[AGENT][NEUTRAL] You would probably have to mail it because I don't think you could submit the EOB electronically so you would probably have to mail the documentation.
[CUSTOMER][NEUTRAL] Right, right, OK, so I'm gonna have to mail, yeah, there's no fax number, yeah, OK, so I'll have to email, so I'll email the EOB and then the CMS 1500, yeah.
[AGENT][NEUTRAL] Uh, you would, you would mail that, yes, to the [PII] address.
[CUSTOMER][NEUTRAL] Right, that's
[CUSTOMER][NEUTRAL] Right, right, I would email, email both of them probably, right? Um, I guess, could I.
[AGENT][NEUTRAL] Not email, not email them, mail them.
[CUSTOMER][NEUTRAL] I mean, I, I'm sorry, I'm sorry, a male, right, yeah, so I would.
[AGENT][NEUTRAL] OK. OK.
[CUSTOMER][NEUTRAL] Yes, so I would, uh, would you mail the CMS and the EOB, or would you do the CMS electronically and then mail the EOB?
[AGENT][NEUTRAL] I'd probably send them together. So you'd probably need to mail them.
[CUSTOMER][NEUTRAL] Yeah, but
[CUSTOMER][POSITIVE] Yeah, probably just regular mail send them both together, yeah, OK, well that's good. Alright, well I really appreciate it.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] Oh, you're welcome, [PII]. Anything else I can assist with today?
[CUSTOMER][POSITIVE] Oh that's great take care bye bye.
[AGENT][POSITIVE] All right, [PII], thanks for calling APL. Have a good day.