AccountId: 011433970860
ContactId: c67f0249-6233-44ca-a9d8-e34f6df715fa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 809140 ms
Total Talk Time (AGENT): 349769 ms
Total Talk Time (CUSTOMER): 183911 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/c67f0249-6233-44ca-a9d8-e34f6df715fa_20250128T19:55_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm trying to find out if the um.
[CUSTOMER][NEUTRAL] Individual policy that I have, um, happens to cover um any mental health services.
[AGENT][NEUTRAL] OK, are you the policy holder?
[CUSTOMER][NEUTRAL] I'm um
[AGENT][NEUTRAL] Are you the policy
[CUSTOMER][NEUTRAL] I'm the policy holder's mother.
[AGENT][NEUTRAL] OK. And what is your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] [PII], what's the policy number, [PII]?
[CUSTOMER][NEUTRAL] OK, the policy number is 02491802.
[AGENT][POSITIVE] And a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Do you spell your name [PII] or [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what is the policy holder's name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Is [PII] available?
[AGENT][NEUTRAL] To get permission to speak with you?
[CUSTOMER][NEUTRAL] No, he
[CUSTOMER][NEUTRAL] Uh, no, he's not, but I can call him at at work and.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, we'll have to get permission from him to to speak with you about his account since you're not on the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'll do that.
[AGENT][NEUTRAL] OK, and you can call us back with him on the phone and then you may wanna also ask him um if you're gonna be calling on his behalf and we can discuss it when he when you call back with him on the phone we could send a.
[CUSTOMER][POSITIVE] Thank you, thank you.
[AGENT][NEUTRAL] Authorization form that he can complete and it basically tells who we can disclose information to and what type of information and that'll be on his file.
[AGENT][NEUTRAL] In his file.
[CUSTOMER][POSITIVE] OK, OK, thank you, bye bye.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][POSITIVE] All right, [PII]. Thank you for calling APL. Have a good day.
[CUSTOMER][POSITIVE] Thanks. Mhm. You too.
[CUSTOMER][NEUTRAL] Did they give you an extension to call him or no?
[CUSTOMER][NEUTRAL] They sent me back to that number that I had called.
[AGENT][NEUTRAL] This is [PII]. Is this [PII]?
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Yes, it is.
[AGENT][NEUTRAL] Oh OK I didn't know. I thought we had disconnected.
[AGENT][NEUTRAL] Let's see, alright, do we have [PII] on the phone?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] [PII], are you on the
[CUSTOMER][NEUTRAL] We do.
[AGENT][NEUTRAL] Hi, [PII]. Can I get, uh, verify some information from you real quick? Uh, your date of birth, your complete mailing address, and your email address?
[CUSTOMER][NEUTRAL] S
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh, mailing address would be [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And your email.
[CUSTOMER][NEUTRAL] Oh, I don't know what email I used to set it up. Is it uh.
[AGENT][NEUTRAL] Looks like your Gmail.
[CUSTOMER][NEUTRAL] Yeah, I have like 5 of them. Is it [PII]? Did I change it to the 1, OK.
[AGENT][NEUTRAL] That's it.
[AGENT][NEUTRAL] It's, it's the first one and thank you for verifying that for me. And we have [PII] on the phone calling uh regarding some uh benefits. Uh, what relationship are you to [PII]?
[CUSTOMER][NEUTRAL] I am her son.
[AGENT][NEUTRAL] OK, and I was telling her of course we have to get your permission to speak with her about anything regarding your policy and we can also email a third party HIPAA authorization form to the email you addressed. You would complete that.
[AGENT][NEUTRAL] And then you would let us know what information can be disclosed and to whom you would state their name.
[AGENT][NEUTRAL] Uh, email that back to us and then we can get that uploaded in your file so that um if she should happen to call we do not need your permission each time she calls. Would you like for us to send that to you?
[CUSTOMER][POSITIVE] Yeah, that'd be great.
[AGENT][POSITIVE] OK. And how can we help today?
[CUSTOMER][NEUTRAL] Well, I wanted to find out if the insurance plan that he had covers um any mental health services.
[AGENT][NEUTRAL] OK. And so now we would need to get [PII]'s permission.
[AGENT][NEUTRAL] And to specifically tell us what what specifically tell us what information we can disclose.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You can disclose any information.
[AGENT][NEUTRAL] OK, OK, and what's the chief complaint?
[CUSTOMER][NEUTRAL] Any at all.
[AGENT][NEUTRAL] What is the diagnosis?
[CUSTOMER][NEGATIVE] Um, depression. And anxiety.
[AGENT][NEUTRAL] OK, OK, and so there is an office visit benefit under the policy, so if you're seeing a primary care doctor or a specialist office, um, that benefit is up to $75 per day, and then you have a maximum of 5 visits in a per calendar year, um, that you can utilize. And of course this information is verification, not a guarantee of payment.
[AGENT][NEUTRAL] And that's for service in a doctor's office?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That would include a psychiatrist, right?
[AGENT][NEUTRAL] Uh, he will be considered an MD, yes, an MD.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Of course, he will be a PhD, but yes, a medical doctor.
[CUSTOMER][NEUTRAL] Is there any
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Any anything else that you think you need to know, [PII]?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] I wonder if he got off the line. I said I'm if I'm being honest I don't.
[AGENT][NEUTRAL] Serious.
[CUSTOMER][NEUTRAL] I'm not really sure what any of my benefits cover.
[AGENT][NEUTRAL] Yeah, so under your um limited hospital indemnity policy, it does have the office visit benefit that we just went over. Um, if you were admitted into a hospital, there is an inpatient benefit. um, and the first time you are admitted into a hospital each year, there's a hospital admission benefit. So that's in addition to the daily uh hospital benefit.
[AGENT][NEUTRAL] Um, you have an intensive care benefit rider under this plan.
[AGENT][NEUTRAL] And there is a
[CUSTOMER][NEUTRAL] OK, is there
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Is there anywhere like on the website or anything I can see this?
[AGENT][NEUTRAL] Mhm. Absolutely. You can create an online account and it houses your policy, your identification card as well.
[CUSTOMER][NEUTRAL] And that would be at a multi plan or?
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] No, no, no, so the APL online service center is secured. [PII].
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Um, did you write that down? I was gonna say, could you repeat that again please, that last part, what the website is I could do?
[AGENT][NEUTRAL] And you
[AGENT][NEUTRAL] Sure, sure. Uh, it's [PII]
[AGENT][NEUTRAL] Sure, [PII]
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] So that's secured. [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I wrote it down, [PII].
[CUSTOMER][NEUTRAL] OK and so.
[AGENT][NEUTRAL] OK. And
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Any coverage for mental health services would just be the doctor visit part.
[AGENT][POSITIVE] Correct, outpatient.
[CUSTOMER][NEUTRAL] And that's good for 5 visits?
[AGENT][NEUTRAL] Correct. 5 visits, um, at up to $75 per visit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I think the answers and everything we needed, right, [PII]?
[CUSTOMER][NEUTRAL] I think so because we get is there any um.
[CUSTOMER][NEUTRAL] Is there anything that has to do with in network or out of network?
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] As far as as responsibilities go?
[AGENT][NEUTRAL] Mhm understood so the uh PPO network of contracted providers for this plan is multi-plan. um, now the, the, the doctor does not necessarily have to be a part of that network to receive a benefit.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] But if they ask you who the network is of providers it is multi plan and I'm sure they're familiar with that with that network.
[CUSTOMER][NEUTRAL] OK, OK. And you can go to the multi plan website to find people that are in network that are already in network.
[AGENT][NEUTRAL] Mhm. So, um, do you have your identification card, [PII]?
[CUSTOMER][NEUTRAL] My insurance card?
[AGENT][NEUTRAL] Uh-huh. On the back of your card is the phone number and website for multiplan.
[AGENT][NEUTRAL] So yes, you can contact them and they could help you locate a doctor within your your area based on your zip code.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Now you said you also said that just because it's not there doesn't mean that they won't cover how do we, how do I know that?
[AGENT][NEUTRAL] Yeah, so when you contact.
[CUSTOMER][NEUTRAL] If they will cover if it's.
[AGENT][NEUTRAL] Yeah, so if you contact Multiplan, um, you give them your zip code, tell them the specialty.
[AGENT][NEUTRAL] Um, which would be psychiatry. They could search based on that information and if they tell you that whichever doctor is not a part of their network, um, the provider can still submit a claim to us. I just won't be at a discounted rate.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] As if you were with Multiplan or the doctor was contracted with Multi-plan, you could possibly receive some type of a discount.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] I don't have any more questions, do you, [PII]? I do not.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, so thank you very much [PII]. I appreciate your time and your help.
[AGENT][POSITIVE] Oh, absolutely, [PII] and [PII], and if no other questions, thanks for calling APL. Have a good day and I wanted to get the uh third party authorization emailed over to you, [PII], so that you can confirm receipt of it. So do you have a quick minute? I'm almost done.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah, yep.
[AGENT][NEUTRAL] OK, give me a second.
[AGENT][NEUTRAL] So that's [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, I just emailed that over to you.
[CUSTOMER][POSITIVE] Alright perfect let me see if I get it.
[AGENT][NEUTRAL] And remember each time um someone else other than you call we'll have to get you on the phone to verify consent to speak with that person.
[AGENT][NEUTRAL] Unless that form is completed and returned to us.
[CUSTOMER][NEUTRAL] Can I put M?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] From [PII].
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] I got it.
[AGENT][POSITIVE] All right, [PII]. So if you guys have no other questions, thank you so much for calling APL and have a good day.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][NEUTRAL] Uh-huh, bye-bye.