AccountId: 011433970860
ContactId: bca24491-3995-4d6f-a6a5-dc0b7ec107bc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 163050 ms
Total Talk Time (AGENT): 78250 ms
Total Talk Time (CUSTOMER): 56490 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/14/bca24491-3995-4d6f-a6a5-dc0b7ec107bc_20250314T14:45_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, and uh my name is [PII] and I'm with the provider's office and I'm trying to verify eligibility and benefits for a patient.
[AGENT][POSITIVE] OK, I can definitely help you with the eligibility and benefits, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Um, there's a policy number and there's a number that says medical ID number. Which one do you need?
[AGENT][NEUTRAL] Um, whichever one starts with a 01 or a 02.
[CUSTOMER][NEUTRAL] OK, 02588075.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII], uh, [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment, and I am showing the policy is active. It's been effective since [PII]. And what type of benefits did you want to go over today?
[CUSTOMER][NEUTRAL] This is for mental health outpatient office setting.
[AGENT][NEUTRAL] OK. Hold on one moment.
[CUSTOMER][NEUTRAL] And I've seen on the card that it that it's limited benefits so I wasn't sure.
[AGENT][NEUTRAL] OK. Let me see what type of policy this is. OK.
[AGENT][NEUTRAL] So it is a hospital indemnity policy, so it is a limited medical policy, um, but some of them do have coverage from mental or behavioral health. Let me see.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] I know we've built the IMA before but for a different patient.
[AGENT][NEUTRAL] Let me see if this policy includes it.
[AGENT][NEUTRAL] No, no, I'm not showing that this policy has coverage for um mental or behavioral health.
[CUSTOMER][NEUTRAL] OK, so would not be covered, correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEGATIVE] OK, shoot, I hate that.
[AGENT][NEUTRAL] I do too.
[CUSTOMER][NEUTRAL] OK, could I get a call reference please?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date, which is [PII].
[CUSTOMER][NEUTRAL] And today's date.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, I will have the clinic reach back out to her and let her know that it won't be covered.
[AGENT][NEUTRAL] All right, [PII]. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] That will be all, thank you so much.
[AGENT][POSITIVE] You're welcome thanks for calling APL and have a good weekend.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.