AccountId: 011433970860
ContactId: d9e1ff41-37d0-431f-8aea-726aca4cebf5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 294070 ms
Total Talk Time (AGENT): 148570 ms
Total Talk Time (CUSTOMER): 84999 ms
Interruptions: 0
Overall Sentiment: AGENT=1.8, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/d9e1ff41-37d0-431f-8aea-726aca4cebf5_20250131T16:12_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] Um, yes, my name is [PII], and I'm I need you, sorry, I'm needing to get outpatient mental health benefits on a patient.
[AGENT][POSITIVE] It would be my pleasure to assist you, [PII]. What is a good callback number?
[CUSTOMER][POSITIVE] It is [PII] and that's correct.
[AGENT][NEUTRAL] Thank you, [PII]. What is the policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Patient's policy number 01874111.
[AGENT][NEUTRAL] And what is the patient's name and? Excuse me, I've got it too.
[AGENT][NEUTRAL] What is the patient's name and date of birth, please, ma'am?
[CUSTOMER][NEUTRAL] It's [PII]. Date of birth is [PII].
[AGENT][POSITIVE] All right, thank you. And it would be my pleasure to assist you with those benefits. Bear with me just one moment, I'm checking on his eligibility.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm actually showing that this policy termed on.
[AGENT][NEUTRAL] [PII]. Let me check to see if he has active coverage with this under another policy number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Oh, he does. Good.
[AGENT][NEUTRAL] Let me get that policy pulled up and I'll give you his active policy information.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. So as of [PII], his active policy number is 257.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 9323.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this is a secondary policy to his major medical.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let me get those benefits pulled up. You're saying mental health benefits in office?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] I'm trying to get this benefits pulled up, bear with me. It's a new policy.
[CUSTOMER][POSITIVE] No problem.
[AGENT][POSITIVE] Now, if it is for treatment, he does have that benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, it's for therapy.
[AGENT][NEUTRAL] Up to
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So for
[AGENT][NEUTRAL] That would could be covered under his outpatient coverage of $3500 per calendar year, and that is a verification of coverage, not a guarantee of payment. And of course, we are secondary to his major medical.
[CUSTOMER][NEUTRAL] In the 3500, that's like a max total he can use.
[AGENT][NEUTRAL] That's correct. Per, per year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And do you show that his Blue Cross is primary?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Because I show on
[CUSTOMER][NEUTRAL] On um our our availity website that that termed on [PII], the Blue Cross.
[AGENT][NEUTRAL] Well, let me go back and check. Oh, I'm sorry, I'm this, this policy is showing United as his major.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 00 so they've changed. OK, OK, I will get back with the patient and ask him what his United is then.
[AGENT][NEUTRAL] Wait a minute, just a second. Let me, let me verify. Hang on, I apologize.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] I have no idea what my computer just did. It just took me to the, hang on.
[AGENT][NEUTRAL] Oh Lord.
[CUSTOMER][NEUTRAL] They have a mind of their own sometimes.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] They do and it just went, I have no idea somewhere else let me.
[AGENT][POSITIVE] Oh my gosh, I'm so sorry. Bear with me. Let me get the correct information for you.
[CUSTOMER][POSITIVE] No problem.
[AGENT][POSITIVE] I'm glad I looked twice when you were saying that I was like.
[AGENT][NEUTRAL] OK, so for Mr. [PII].
[AGENT][POSITIVE] I'm showing his major medical to be community care.
[CUSTOMER][POSITIVE] Oh, that's even better.
[CUSTOMER][POSITIVE] I like them better.
[AGENT][POSITIVE] I'm so glad.
[CUSTOMER][POSITIVE] Yeah, well, I appreciate your time and do I, do you have a reference number or how does that work?
[AGENT][NEUTRAL] It's gonna be my name in today's date, and I spell my name [PII] my [PII].
[CUSTOMER][NEUTRAL] OK,
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] OK, sounds good thank you so much for your time I appreciate it you have a great day.
[AGENT][POSITIVE] I it's been a pleasure to help you with those benefits. Thank you for calling APL. I hope you have a great day and a happy weekend.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you, I do. Take care. Bye-bye.
[CUSTOMER][NEUTRAL] Mhm bye bye.