AccountId: 011433970860
ContactId: fbb2242e-e76d-4d12-8d09-fa7ba0dc01e8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 446920 ms
Total Talk Time (AGENT): 192479 ms
Total Talk Time (CUSTOMER): 182400 ms
Interruptions: 3
Overall Sentiment: AGENT=1.3, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/fbb2242e-e76d-4d12-8d09-fa7ba0dc01e8_20250521T13:17_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, good morning. I'm calling from Managemental Health. We are a medical provider, I mean a mental health provider. Um, I'm calling because we have a patient that um has this gap insurance as a secondary insurance. And uh I just wanna make sure about the benefits for this member and also know how can I create a user account for our office in order to send the claims.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, sure, yes, I can assist you with all that information. May I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Of course. My name is [PII]
[AGENT][POSITIVE] Thank you and may I have the callback number just in case we get disconnect.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] 02497462 M as in Mary, L as in Louis, and number 8.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yes, it's [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, so the.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] And you said you need benefits today and what type of service is being rendered?
[CUSTOMER][NEUTRAL] It's outpatient mental health.
[AGENT][NEUTRAL] OK, is this like a psychiatrist, um, or is it like.
[CUSTOMER][POSITIVE] It is correct, it's psychotherapy.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let me check and see if she has benefits and it's gonna be um bill that's in office, correct?
[CUSTOMER][NEUTRAL] Um, it's gonna be in office, yes, probably in the future it's gonna be in virtual sessions, but for now it's gonna be in office.
[AGENT][NEUTRAL] OK, OK, got you.
[AGENT][NEUTRAL] OK, 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.
[AGENT][NEUTRAL] And with this one, let's see.
[CUSTOMER][NEUTRAL] Mhm, OK.
[AGENT][NEUTRAL] Mm, like we only cover treatment. Let me double check. OK, one moment.
[AGENT][NEUTRAL] Important documents.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so yes, it does cover the office visit and it covers the office treatments as well. The office treatments are subject to the outpatient maximum which is $250 per day. Um, the office visit, bear with me, let me see how much we cover on that one.
[CUSTOMER][NEUTRAL] Mm mhm.
[AGENT][NEUTRAL] Again, this is not a guarantee of payment, just a verification of coverage.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, for a specialist office visit, we cover up to $50 per visit, maximum of 4 visits per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK, now when submitting that claim, is there any specific CPT code that I have to use or just a regular CPT code that we use with the primary insurance?
[AGENT][NEUTRAL] Yeah, it's gonna be the same information that you use with the primary insurance. We follow primary, um, if they approve and apply towards the deductible co-payment and co-insurance and if they cover service, we'll go ahead and pay on it.
[CUSTOMER][NEUTRAL] Or do I have to send it or the or the health plans would send it directly to you?
[AGENT][NEUTRAL] No, it has to be sent directly. Yes, it has to be sent directly by the provider of service, mhm, they don't cross over.
[CUSTOMER][NEUTRAL] I have to send it, right?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and the charge amount, uh, the charge amount will be that part that wasn't covered by the past plan.
[AGENT][NEUTRAL] It's gonna be the part that is applied towards the deductible, co-payment and co-insurance.
[CUSTOMER][NEUTRAL] OK, now I have another question. I was trying to create that account online. uh, when I go to the new user tab, it's asking me for my tax ID and it's asking me for the patient account number. I mean, the patient is uh supposed to be seen tomorrow but I don't have an account number for her yet.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] How can I create that account?
[AGENT][NEUTRAL] You're gonna need a patient's account. Mhm. Yes. Mhm.
[CUSTOMER][NEUTRAL] Do I have to wait for the patient?
[CUSTOMER][NEUTRAL] OK, that account number, it's the member ID of the Premier insurance, so it's any random number that we assigned here in the office.
[AGENT][NEUTRAL] Yeah, it's gonna be the number that you assigned in the office that long number that is the um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, in that case I already have a number for her, but when I'm trying to create an account, I put the tax ID and that account number it says that wasn't able to find that information in the system.
[AGENT][NEUTRAL] Yes, that's because we don't have that information yet until we receive the claim and process the claim, you're, we're gonna have that uh number in the system, but before then we don't have that in the system.
[CUSTOMER][NEUTRAL] Oh, so I have to I have to send the first claim and then create an account.
[AGENT][NEUTRAL] Yes, or if you have another patient that we have already seen and you have already received a, OK, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm, no, I don't. I don't have any other patients, so how can I, how can I send the first claim?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, you can send it by fax or mail.
[CUSTOMER][NEUTRAL] Mhm. OK, what's the fax number?
[AGENT][NEUTRAL] Fax number is [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] [PII] and it's a regular CMS [PII]?
[AGENT][NEUTRAL] 23.
[AGENT][POSITIVE] Mhm. Perfect, yes.
[CUSTOMER][NEUTRAL] OK, it's [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, perfect. Then after I send that how many days it's gonna take, you know, to be updated so I can go ahead and create that account?
[AGENT][NEUTRAL] Uh, it process within 7 to 10 business days.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] I mean, 72 hours, right? Or days?
[AGENT][NEUTRAL] 77 to 10 business days.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Perfect. OK, sounds good thank you so much for your help today.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] You're welcome. Is there anything else I'm gonna help you with today?
[CUSTOMER][POSITIVE] No, no, for now, thank you.
[AGENT][POSITIVE] Mhm. You're welcome and thank you for calling APO. Have a good day. Mm bye bye.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you.