AccountId: 011433970860
ContactId: fb016cee-d5d4-48bc-be30-cf7c98893f24
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 350019 ms
Total Talk Time (AGENT): 101494 ms
Total Talk Time (CUSTOMER): 186774 ms
Interruptions: 3
Overall Sentiment: AGENT=0.2, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/fb016cee-d5d4-48bc-be30-cf7c98893f24_20250211T18:50_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hey, [PII]. My name is uh [PII]. I'm calling from Nicholas Children's Hospital.
[AGENT][NEUTRAL] OK, [PII], do you have a phone number in case we get disconnected I can call you back?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, sure, the number is [PII].
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] Uh, yes, I do have the policy number. Just give me one quick minute. The
[CUSTOMER][NEUTRAL] The policy number is
[CUSTOMER][NEUTRAL] Well.
[CUSTOMER][NEUTRAL] Mm, just give me one quick minute.
[CUSTOMER][NEUTRAL] Yeah, uh, it's 1320.
[CUSTOMER][NEUTRAL] 562.
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima, number 8.
[AGENT][NEUTRAL] Thank you, hold on one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what's the patient's name?
[CUSTOMER][NEUTRAL] Patient's name is
[CUSTOMER][NEUTRAL] First name is [PII], and the last name is [PII].
[AGENT][NEUTRAL] And the date of birth.
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Thank you, [PII], and were you needing claim status or benefits?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Were you needing claim status or benefits?
[CUSTOMER][NEUTRAL] Uh, no. Uh, I just want to check the eligibility and benefits and also I need to check the, uh, uh, benefits for, uh, mental health.
[CUSTOMER][NEUTRAL] Actually, this, this insurance is going to be the secondary insurance. So I just want uh the, yeah, I just want to check that whether uh it, it's effective or not.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] OK, hold on one moment please.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] The name is [PII], right?
[AGENT][NEUTRAL] Yes, [PII]
[CUSTOMER][POSITIVE] Thank you so much, [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] You can go ahead and take your time and you can check this information for me. Thank you.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] OK, they do have another policy.
[AGENT][NEUTRAL] That policy number is 02.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 331-317.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so it's going to be the same um.
[AGENT][NEUTRAL] It was a
[CUSTOMER][NEUTRAL] It's going to be the same, uh, it's, may I know the effective date, please?
[AGENT][NEUTRAL] The effective date is [PII].
[CUSTOMER][NEUTRAL] Uh, uh, could you please, uh, confirm, uh, for which, uh, member ID you are providing this information because I have, uh, the member ID which you provided to you before, uh, is 132.
[AGENT][NEGATIVE] That policy canceled.
[CUSTOMER][NEUTRAL] OK. So, the another one is, yeah, OK, OK. OK, OK. So, the new policy number is 02331317, right, [PII]?
[AGENT][NEUTRAL] That you gave me 4123.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Thank you so much. And uh may I know uh the benefits for mental health, please?
[AGENT][NEUTRAL] Is this for outpatient, doctor's office, or?
[CUSTOMER][NEUTRAL] Out, outpatient, outpatient office setting.
[AGENT][NEUTRAL] Do you know how it's going to be filed [PII] or for an office visit or?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um, you mean you're asking about, uh, the data service, right?
[AGENT][NEUTRAL] The place of service. Is it gonna be a [PII] or [PII]?
[CUSTOMER][NEUTRAL] Yeah, place of service is office, office, uh, it's [PII].
[AGENT][NEUTRAL] Do you know what the code would be?
[CUSTOMER][NEUTRAL] Uh, just give me one quick minute.
[AGENT][NEUTRAL] Because I'm asking because office visits aren't covered under this policy, but if they have services done.
[AGENT][NEUTRAL] Like therapy, it would be covered under their outpatient benefit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, it's going to be like [PII] only.
[AGENT][NEUTRAL] Huh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] For that, you need the CPT code.
[AGENT][NEUTRAL] Um, is it gonna be an office visit or is it gonna be like services?
[CUSTOMER][NEUTRAL] No, it, it's, uh, it's going to be office visit, [PII].
[AGENT][NEUTRAL] OK, office visits aren't covered under this policy.
[CUSTOMER][NEUTRAL] OK. So it's non-covered. OK. And uh because the primary is covering uh uh
[CUSTOMER][NEUTRAL] This office settings, right?
[AGENT][NEUTRAL] Yeah, they may, but office visits aren't covered under our policy.
[CUSTOMER][POSITIVE] OK, thank you so much for this information and I would like to uh
[AGENT][NEUTRAL] It just depends on how it's gonna be filed, so we would have to see the claim before we can make a decision.
[CUSTOMER][POSITIVE] OK, fine. Thank you so much, [PII]. So may I know uh the uh call reference number for this call, please?
[AGENT][NEUTRAL] We do not have call reference numbers. You can use my name in today's date.
[CUSTOMER][NEUTRAL] Uh, uh,
[CUSTOMER][POSITIVE] OK, OK, OK, thank you so much, uh, [PII]. I have updated this information from my end, so thank you so much for providing me this valuable information. So, uh, that's it from my end, [PII]. Have a great day. Bye bye.
[AGENT][POSITIVE] Thank you, [PII] for calling APLU as well. Bye-bye.
[CUSTOMER][POSITIVE] Bye-bye. Thank you.