AccountId: 011433970860
ContactId: ea291fce-168a-4d27-b563-fb3dd1e5c5f3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 204440 ms
Total Talk Time (AGENT): 86529 ms
Total Talk Time (CUSTOMER): 78348 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/28/ea291fce-168a-4d27-b563-fb3dd1e5c5f3_20250328T19:45_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] from Mental Health Specialty Group. Please be advised that this call is recorded for quality and training purposes. I'm calling to check for benefits and eligibility for outpatient telehealth visit under mental health.
[AGENT][NEUTRAL] OK, sure, Ms. [PII], I can assist you with that benefit and eligibility information. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Callback number would be direct line [PII].
[AGENT][NEUTRAL] I'm sorry, can you repeat that? [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And what's the name of the facility you're calling from, Ms. [PII]?
[CUSTOMER][NEUTRAL] Mental health specialty group.
[AGENT][NEUTRAL] OK. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Policy number
[CUSTOMER][NEUTRAL] 02137685.
[AGENT][NEUTRAL] OK, thank you. One moment.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Name would be.
[CUSTOMER][NEUTRAL] [PII], date of birth [PII].
[AGENT][NEUTRAL] Thank you. All right, let me check the benefits on this policy and before I give you any benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer. And this is one of our secondary supplemental plans for the major medical.
[AGENT][NEUTRAL] And um let me check and see if it has any office space with.
[AGENT][NEGATIVE] OK, so this one doesn't have office visit benefit or tele telehealth is considered an office visit, so it's not gonna be covered because it doesn't have any coverage for office visit on this one.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, so it's like a limited benefit plan, right?
[AGENT][NEUTRAL] It's a um it's a secondary supplemental plan. It just doesn't cover office visit co-payment.
[AGENT][NEUTRAL] Or kind of health.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Does not cover telehealth of our office. One sec, OK.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Thank you. Not covered one sec, and may I have your first name and last name initial, please?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] My first name is [PII]. That's [PII].
[CUSTOMER][NEUTRAL] Thank you and just to repeat our conversation, this is a supplemental plan and.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Outpatient telehealth visit for mental health is not covered because it does not cover office visit, which applies for telehealth, OK?
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Correct. Mhm.
[CUSTOMER][NEUTRAL] Alright, may I have the reference number for this call, please?
[AGENT][NEUTRAL] We don't have reference numbers you can use my name in today's date.
[CUSTOMER][POSITIVE] OK, thank you so much for helping me solve that's all I need to know. Have a good day bye bye.
[AGENT][POSITIVE] You're welcome. Thank you for calling PR. Bye-bye.