AccountId: 011433970860
ContactId: fd0c8a39-e547-4511-b6fb-f419ce4d369b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 374709 ms
Total Talk Time (AGENT): 136290 ms
Total Talk Time (CUSTOMER): 156401 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/fd0c8a39-e547-4511-b6fb-f419ce4d369b_20250107T14:55_UTC.wav
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[AGENT][POSITIVE] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, I'm sorry, what did you say your name was?
[AGENT][NEUTRAL] Um, it's [PII]. Um, it's spelled [PII] and my last initial is [PII].
[CUSTOMER][NEUTRAL] Hey, [PII]. This is [PII] with Lake Area Psychiatry. Um, I was calling to verify this patient's insurance.
[AGENT][NEUTRAL] I'm sure, [PII], I can assist you with benefits. Um, first, I'll need a good callback number in case we're disconnected.
[CUSTOMER][NEUTRAL] Yes, ma'am, it is [PII].
[AGENT][NEUTRAL] OK. Thank you. Now, I need the policy number, please.
[CUSTOMER][NEUTRAL] Policy number is 01633180.
[AGENT][NEUTRAL] Please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Thank you and just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII] and the policy is still active. And is this for office visits?
[CUSTOMER][NEUTRAL] Um, yes, yes, it's a mental health office, um, mental health office is like outpatient, outpatient office visit.
[AGENT][NEUTRAL] OK. For all outpatient office visits, including mental health, we cover up to $100 per visit and she gets 4 visits per calendar year.
[CUSTOMER][NEUTRAL] Covers up.
[CUSTOMER][NEUTRAL] To $100 per visit.
[CUSTOMER][NEUTRAL] And how many visits?
[AGENT][NEUTRAL] For visits per calendar year.
[CUSTOMER][POSITIVE] OK, so if she has um Blue Cross Blue she has Blue Cross Blue Shield as a primary and she has a $40 co-pay, y'all, y'all, y'all will cover that. She does not have to pay.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, I'm showing that this is a hospital indemnity plan. This is also a primary insurance. I'm not showing that she has a secondary insurance with us.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] Interesting, OK.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] OK, so, um, uh.
[CUSTOMER][NEUTRAL] So, and you, you have her as a, that she, that this is a primary insurance.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Please verify her name and date of birth one more time. Sure.
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII]. She said her husband was the policyholder, [PII].
[AGENT][POSITIVE] Um, yes, ma'am. This is the correct policy.
[CUSTOMER][NEUTRAL] Date of birth.
[CUSTOMER][NEUTRAL] OK. hm, OK, so you have her, uh, insurance has her as primary insurance.
[CUSTOMER][NEUTRAL] Um, not.
[CUSTOMER][NEUTRAL] Secondary.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And you said this is a hospital dignity plan, so it
[CUSTOMER][NEUTRAL] Can you, can you explain that to me? I'm sorry, I've never dealt with this insurance before.
[AGENT][NEUTRAL] Um, yes, ma'am. It's a hospital indemnity plan. Most of the coverage is for hospital services, but we do cover some outpatient benefits such as office visits, and like I said, she gets up to $4 per calendar year and we'll cover up to $100 per visit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, OK, so I need to call her and I.
[CUSTOMER][NEUTRAL] And let her know that you all have her as a, as her primary.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, so what, what would happen if
[CUSTOMER][NEUTRAL] We send it to Blue Cross Blue Shield and then to y'all.
[AGENT][NEUTRAL] Um, it would, it wouldn't pay because, um, it already paid by Blue Cross, so.
[CUSTOMER][NEUTRAL] Yes, I am.
[CUSTOMER][NEUTRAL] OK, OK, um, can I get a good claims address for y'all?
[AGENT][NEUTRAL] Um, yes, it is IMA.
[CUSTOMER][NEUTRAL] I am a.
[AGENT][NEUTRAL] And that goes mhm and that goes to [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And there's also a pair ID.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] Yes Sam.
[AGENT][NEUTRAL] Um, the pay ID is 64556.
[CUSTOMER][NEUTRAL] All right. Do y'all cover, um, do y'all cover telehealth as well?
[AGENT][NEUTRAL] Um, no, ma'am. It's not covered.
[CUSTOMER][NEUTRAL] No tell her.
[CUSTOMER][POSITIVE] OK. Perfect. So,
[CUSTOMER][NEUTRAL] Y'all, um
[CUSTOMER][NEUTRAL] Can y'all be, are, are y'all a supplemental plan as well or only primary or secondary?
[AGENT][NEUTRAL] Um, there is a policy for, um, secondary insurance, but she's not enrolled in that one.
[CUSTOMER][NEUTRAL] OK, yes, ma'am. Alright, uh, OK, that should be everything. I'm gonna give this [PII] a call to get it straightened out. Uh, can I have just a good call reference number, please?
[AGENT][NEUTRAL] Um, yes, for the reference number, you can use my name and today's date. My name is [PII], um, it's spelled [PII] My last initial is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And today's date. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] That should be everything.
[AGENT][POSITIVE] OK. Well, I thank you again, sir, for calling APL. You have a great rest of your day. Mm bye.
[CUSTOMER][POSITIVE] Yes, ma'am. Thank you. bye.
[AGENT][POSITIVE] Mhm. You're welcome. Bye.