AccountId: 011433970860
ContactId: dec0d565-1627-43a1-bb9b-9225048e11b1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 349200 ms
Total Talk Time (AGENT): 153481 ms
Total Talk Time (CUSTOMER): 118846 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/dec0d565-1627-43a1-bb9b-9225048e11b1_20250115T20:18_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I'm calling to verify if a member has active coverage.
[AGENT][POSITIVE] Oh yeah, I'd love to help you with that today. And do you have a good call back number I can snack from you real quick?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][POSITIVE] Perfect. And the member's policy number?
[CUSTOMER][NEUTRAL] 02455568
[AGENT][POSITIVE] Perfect and
[AGENT][NEUTRAL] One second while I get that pulled up for you.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] All righty. Would you be able to verify for me, pretty please, your patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Perfect. I see [PII] here. He is current and active on this policy with an effective date of [PII]. Um, but this insured does have an updated policy number. Can I give that to you?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][POSITIVE] Perfect. It looks like the new policy number is going to be 02583472.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then as far as eligibility goes, oh yeah, there's a group number I can get that for you.
[CUSTOMER][NEUTRAL] Is there a group number?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I have a group number listed as 17934.
[CUSTOMER][NEUTRAL] OK, same, OK.
[AGENT][NEUTRAL] And then is there any other information you're needing for eligibility?
[CUSTOMER][NEUTRAL] Um, yes, the payer ID.
[AGENT][NEUTRAL] 60801
[CUSTOMER][NEUTRAL] And it was on the calendar year.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And then, um, that is, uh, there was an annual maximum last 20 years is there one this time?
[AGENT][POSITIVE] Yeah, I can um pull up benefits for you inpatient or outpatient.
[CUSTOMER][NEUTRAL] Outpatient office.
[AGENT][NEUTRAL] All right. I do want to let you know any benefit information I give you over the phone. It's just a verification of coverage and not a guarantee of payment, and it looks like our outpatient.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Benefits
[AGENT][NEUTRAL] Sorry, there's a lot on here.
[CUSTOMER][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] I'm so sorry, um, thanks for your patience. The inpatient, outpatient, um, max is actually combined combined, and it's $5000 per calendar year, and I don't know if I said this already, so I'm sorry if I've said it twice, but I did just wanna let you know any um benefit information could be verification coverage and not a guarantee of payment.
[CUSTOMER][POSITIVE] It's all right.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm, OK, yeah, you said that, so it's 5,0004, is that for treatment only?
[AGENT][NEUTRAL] Um, it's for all of their benefits, $5000 a calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 50 per calendar year. One second per calendar, OK, um, and then, and there's no lifetime maximum.
[AGENT][NEUTRAL] A lifetime now.
[CUSTOMER][NEUTRAL] OK, um, one second, and no is authorization required?
[AGENT][NEUTRAL] Uh, no, we'll follow their major medical.
[CUSTOMER][NEUTRAL] Major.
[CUSTOMER][NEUTRAL] Up to 5000.
[CUSTOMER][NEUTRAL] For calendar year, specifically with treatment services only apply to treatment is it.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] OK, I just, um, just wanted to go over this part that I received the last time I verify, um, just let me know if it's true or not, is, uh, what she quoted to me that this policy covers primary insurance copays for up to the, um, annual maximum per calendar year specifically for treatment services only applies to treatment visits for mental and emotional health disorders.
[CUSTOMER][POSITIVE] Sounds about right.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] No, I mean, we do cover, we do try to pick up the copay, co-insurance or deductible. It's applied to that for major medical, um, typically we don't cover administrative charges, so consultations, those stuff. So yes, like treatments is on there, but we have like diagnostic testing and.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, yeah.
[AGENT][NEUTRAL] Fusion therapy, occupational therapy, physical therapy, sleep studies, treatment in an emergency room. So like there's, it's more than just emotional mental disorders, which by the way, is also on there too. Um, so there's like a lot of coverage as far as that goes.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][POSITIVE] OK, alright, no problem, thank you so much. Um, you said it was [PII]?
[AGENT][NEUTRAL] Um, I, yes, and then last initial [PII].
[CUSTOMER][NEUTRAL] Uh oh.
[CUSTOMER][NEUTRAL] And then is there a reference number for today's call?
[AGENT][NEUTRAL] It's just my name, my last initial, and today's date.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Thank you [PII] you have a good day.
[AGENT][POSITIVE] Oh, it's my pleasure, Ms. [PII]. Did I say that right? Um, you, you have a wonderful day as well. Thank you for calling APL.
[CUSTOMER][POSITIVE] Yes you did yes.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye.