AccountId: 011433970860
ContactId: e1426b12-c68c-4946-815e-533c54f6409f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 651859 ms
Total Talk Time (AGENT): 249815 ms
Total Talk Time (CUSTOMER): 152570 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/e1426b12-c68c-4946-815e-533c54f6409f_20250123T18:07_UTC.wav
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[AGENT][NEUTRAL] APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Can I give you a call? OK. Hi [PII].
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] I am [PII] with Forest View Hospital, and I am looking to understand benefits on a policy.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and spell your first name for me.
[CUSTOMER][NEUTRAL] Yes, [PII]
[AGENT][NEUTRAL] OK, and what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] My direct [PII].
[AGENT][NEUTRAL] And, uh, is it pertaining to a particular patient's policy number policy?
[CUSTOMER][NEUTRAL] Yes, mhm.
[AGENT][NEUTRAL] And what's that number?
[CUSTOMER][NEUTRAL] The um policy number is 02230083.
[AGENT][POSITIVE] Thank.
[AGENT][NEUTRAL] And what's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, thank you. So her effective date is [PII] currently active?
[CUSTOMER][NEUTRAL] Mhm
[AGENT][POSITIVE] And the maximum outpatient benefit, let me get that for you.
[AGENT][NEUTRAL] It's up to 5000.
[CUSTOMER][NEUTRAL] Um, when you, um, bear with me, when you say outpatient, this is inpatient are there benefits?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] There is a difference. So outpatient, I mean outpatient hospital, so inpatient hospital is a different benefit, so the maximum, thanks for clarifying the maximum inpatient benefit is up to $6350.
[AGENT][NEUTRAL] Per calendar year.
[AGENT][NEUTRAL] And information provided is verification, not a guarantee of payment.
[AGENT][NEUTRAL] And let me check her. I don't show she's happy that she has any claims on file uh for this year, so that amount is available.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, and so does that cover the primaries um policy? What it does not cover the deductible and co-insurance up to that 6350?
[AGENT][NEUTRAL] So the Metlink policy by APL considers the deductible amount, the co-insurance amount, and co-payment amounts of coverage charges up to 6350. What's the inpatient stay for?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, uh, behavioral health.
[AGENT][NEUTRAL] What's the diagnosis, if you have that?
[CUSTOMER][NEUTRAL] Uh, let, I may, but I may not. I'm not clinical. I verify, um, F32A.
[CUSTOMER][NEGATIVE] Unspecified depression.
[CUSTOMER][NEUTRAL] That may have changed at this point, but
[AGENT][NEUTRAL] Give me 1 2nd.
[AGENT][NEUTRAL] And so is this a.
[AGENT][NEUTRAL] I know you said that it's Forest View Hospital. Is it specific to
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Not necessarily psychiatric, but is it just in a standard hospital facility?
[CUSTOMER][NEUTRAL] No, we are a psychiatric hospital.
[AGENT][NEUTRAL] OK, good to know. One moment.
[AGENT][NEUTRAL] Give me 1 2nd.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Just a few more minutes.
[CUSTOMER][POSITIVE] Yeah, you're good.
[AGENT][NEUTRAL] Can I place you on a brief hold, OK?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 01 moment.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][NEUTRAL] This is evening.
[AGENT][NEUTRAL] Hi, [PII], this is [PII]. How are you?
[CUSTOMER][POSITIVE] I'm good. How are you?
[AGENT][NEUTRAL] Good, I have a question.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] So it's for, it's regarding a Metlink policy, Metin Metlink 6, and the policy number is 223.
[AGENT][NEUTRAL] 0083.
[AGENT][NEUTRAL] And it's for part 2 [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I have, I have a provider on the line and, and she's wanting um inpatient benefits for, um, it's an inpatient psychiatric facility um for uh major depression. Um, is that pla location covered? Psychiatric hospital?
[CUSTOMER][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] And I'm looking at the policy, and then I'm gonna move to the exclusions.
[AGENT][NEUTRAL] As well.
[CUSTOMER][NEUTRAL] It sounds like it'll be covered um as long as it's not taking place at home and she'll be admitted.
[AGENT][NEUTRAL] Yeah, cause it's due to it.
[AGENT][NEUTRAL] Right. And it's due to a treatment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Sickness, I mean sickness, a sickness.
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] Yeah, I'm looking over the policy too.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So in the exclusions it says an expense that does not meet the definition of inpatient cover charge or outpatient so I'm gonna go back up to the definition.
[AGENT][NEUTRAL] It says inpatient, uh, inpatient, it says confined in a hospital for at least 18 continuous hours.
[AGENT][NEUTRAL] Um, the charges that are incurred by a covered person because of an accident or sickness for necessary treatment services and medical supplies, and recommended by a hm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And it's not
[CUSTOMER][POSITIVE] Yeah, and it's not listed under exclusions. I believe that it will be covered.
[AGENT][POSITIVE] OK. All righty. OK, thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Anything else?
[AGENT][POSITIVE] That'll be it, Evie. Thank you so much.
[CUSTOMER][POSITIVE] OK. You're welcome, [PII]. Have a good one.
[AGENT][NEUTRAL] Um, you too. Bye-bye.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][POSITIVE] [PII], thank you so much for holding. I had to confer confer with the claims department because this is, I know a accredited uh facility, correct?
[CUSTOMER][NEUTRAL] It was
[CUSTOMER][POSITIVE] Yes we are.
[AGENT][NEUTRAL] And then the treatment is as a result or ordered by a physician.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, all right, and so.
[AGENT][NEUTRAL] Um, the 6350, 6350 up to that amount per calendar year, whatever amount the primary applies towards deductible co-insurance and or co-pay amounts, um, this policy helps in assistance with those, um, categories.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Yes, yes, got it and then um is there an electronic payer ID for us to send our claims to or no?
[AGENT][NEUTRAL] Of course. I don't know if you could send them electronically because we'll need the copy of the primary EOD.
[AGENT][NEUTRAL] As well.
[CUSTOMER][NEUTRAL] OK, so only the, the mailing for the claims then we did no electronic.
[AGENT][NEUTRAL] Or you can or you.
[AGENT][NEUTRAL] Well, we do have a payer ID number but usually it's just for the itemized bill. I don't know if you could do attachments. I'm not for sure, but our payer ID is 660801.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] ID and then I've got the address and the fax so I'm good there. Alright, let's see, I will take the reference number for our call please.
[AGENT][NEUTRAL] It's my name and today's date, [PII]
[AGENT][NEUTRAL] And first initial of my last name is [PII].
[CUSTOMER][POSITIVE] Alrighty thank you [PII] have a good weekend it's just around the corner.
[AGENT][POSITIVE] I know. You, you too, [PII], and thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Goodbye.
[AGENT][NEUTRAL] OK.