AccountId: 011433970860
ContactId: deb78b15-0599-46b9-82d5-4ab8f410671a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 530859 ms
Total Talk Time (AGENT): 219055 ms
Total Talk Time (CUSTOMER): 233345 ms
Interruptions: 4
Overall Sentiment: AGENT=0.7, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/deb78b15-0599-46b9-82d5-4ab8f410671a_20250220T21:09_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello [PII], uh, my name is [PII], and I'm calling from, uh, the Sloan Center, uh, for Doctor [PII]. It's regarding, uh, behavioral health and, uh, getting the, the gap payment to cover a, uh.
[CUSTOMER][NEUTRAL] A United Healthcare co-pay.
[AGENT][POSITIVE] OK, [PII], I can help you with, um, the benefits.
[AGENT][NEUTRAL] I'm sorry for this, um, call. Can I please get your callback number, sir, just in case call is disconnected?
[CUSTOMER][NEUTRAL] OK, um, it is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, sir. And what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] The, uh, it's the, the child of uh the insured is [PII], um, and it says coverage employee and child the the child's name is [PII].
[CUSTOMER][NEUTRAL] You want the the group number?
[AGENT][NEUTRAL] No, sir. I need the child's date of birth and then the policy number, please.
[CUSTOMER][NEUTRAL] OK, yeah, right, his date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And then what is the policy number, sir?
[CUSTOMER][NEUTRAL] It is um.
[CUSTOMER][NEUTRAL] Two, well, let's see, I mean, you got nothing ever says policy number, but a group number is 23326.
[AGENT][NEUTRAL] OK, do you see an inpatient or an outpatient certification number?
[CUSTOMER][NEUTRAL] Yes, outpatient certification number 02032991 M as in mom, L as in Louie and 8.
[AGENT][NEUTRAL] OK, let me look up that policy for us real quick.
[AGENT][NEUTRAL] OK, I do show that Doll does have an active policy. Effective date is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And this is just to verify uh coverage. It's not a guarantee of payment you're correct, this is the supplemental policy, a gap insurance that helps with deductible, co-pay, and co-insurance. The insured has an outpatient calendar year benefit amount of $7350.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] And I'm going to pull the policy in just to double check about mental health to see.
[AGENT][NEUTRAL] Or behavior health. I'm sorry, you said.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] To see about that and if they have office visits.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And the other thing is, uh, how we would send the, uh, you know, we have, we certainly have the uh United Healthcare.
[AGENT][NEUTRAL] And it's gonna be
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] A remittance form of what they're providing for the sessions we've had so far.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, um, so if you need to send in the claim, there's 3 different ways you can do it. You can do it by, um, electronically, and I can give you your ID number.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, we would do that.
[AGENT][NEUTRAL] It's 60801.
[CUSTOMER][NEUTRAL] 60801.
[AGENT][NEUTRAL] Yes, sir, or you can fax it in, and that number is 1877.
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And when we do go ahead, I'm sorry.
[AGENT][NEUTRAL] Or if you
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Or if you choose to mail it in, I can give you the mailing address.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] That's the [PII]. OK, but in terms of if we were to do it online and you that 60801 is is what do you call that a reference number?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] It's a payer ID number?
[CUSTOMER][NEUTRAL] That's the payer ID number.
[CUSTOMER][NEUTRAL] And we go to.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] What is the website we would go to for making that?
[AGENT][NEUTRAL] Uh, we have an online service center.
[CUSTOMER][NEUTRAL] That submitting that information.
[AGENT][NEUTRAL] Right, we have an online service in so if you sent a in before with us you would use the patient account number that you provide.
[CUSTOMER][NEUTRAL] Mhm yeah we haven't done it before. This would be a first time that's.
[AGENT][NEUTRAL] And sign up for the online service center and go through there.
[CUSTOMER][NEUTRAL] Yeah this would be the first time we do this.
[AGENT][NEUTRAL] OK, so after
[CUSTOMER][NEUTRAL] Mhm, and you've been cutting in and out. I'm sorry.
[AGENT][NEUTRAL] So after you file a claim this time.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And and how do we first file a claim?
[AGENT][NEUTRAL] So after you file a.
[AGENT][NEUTRAL] Uh, you, the first claim will have to be through, um, the fax or mail in the claim for the insured.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, the first time it has to be faxed or mailed.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And what we submit is the
[CUSTOMER][NEUTRAL] What the original.
[CUSTOMER][NEUTRAL] Explanation of benefits from the primary insurer.
[AGENT][NEUTRAL] Yes, the explanation of benefits, the itemized statement.
[AGENT][NEUTRAL] Will be submitted along with the claim form.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, well I'll discuss that with Doctor [PII] and, and I, this stuff's kind of new for me as far as trying to be uh helpful with her and, and a lot of these new insurance things kept popping up all over the place, you know.
[AGENT][NEUTRAL] Yeah, OK, that's OK.
[CUSTOMER][NEUTRAL] With, uh, and you know, with, with different clients, you know, this is the first time we've had the American public life met a gap.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Set up which is what the uh.
[AGENT][NEUTRAL] Yes sir.
[CUSTOMER][POSITIVE] The family wishes us to apply for.
[CUSTOMER][NEUTRAL] Covering that those co-pays.
[AGENT][NEUTRAL] OK, so on their policy they.
[AGENT][NEUTRAL] Yes, sir. I understand it and it can be very confusing. I know it's.
[AGENT][NEUTRAL] Handle one kind with our company. I can imagine you going through all different types of insurance.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so
[AGENT][NEUTRAL] Patient's policy physician office is not included as covered outpatient facility, so the outpatient facility uh that they would be able to get reimbursement for would be an ER urgent care center, MRI imaging center or an ambulatory center for accident or sickness.
[CUSTOMER][NEUTRAL] Oh, so this doesn't cover the gap for behavioral health therapy.
[AGENT][NEUTRAL] Right. And it's for accident or sickness.
[CUSTOMER][NEUTRAL] Only accident and sickness in a urgent care.
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK, so in a way that's telling me right now that they will have to pay their own co-pay out of pocket.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Since this is not accidents.
[CUSTOMER][NEUTRAL] At a uh
[CUSTOMER][NEUTRAL] You know, outpatient emergency care center.
[CUSTOMER][NEUTRAL] Alright well I will contact the client and if they want to follow up with you guys I will hand it over to them.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] OK, sounds perfect.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][POSITIVE] Thank you so much, [PII].
[CUSTOMER][POSITIVE] All right, I wish you well.
[CUSTOMER][POSITIVE] Yeah thank you bye bye.
[AGENT][POSITIVE] I wish you well too and I appreciate you calling APL bye bye sir.
[CUSTOMER][NEUTRAL] OK bye bye.