AccountId: 011433970860
ContactId: 0472633f-c9ac-4fe5-9aec-58641ef63de9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 506690 ms
Total Talk Time (AGENT): 154645 ms
Total Talk Time (CUSTOMER): 125719 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/18/0472633f-c9ac-4fe5-9aec-58641ef63de9_20250618T19:43_UTC.wav
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[AGENT][POSITIVE] Thanks for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], this is [PII] with therapy specialist. Um, I was calling to check a members.
[CUSTOMER][NEUTRAL] Insurance benefits and um eligibility, and this is the only number that was listed on their insurance portion of the referral that I received.
[CUSTOMER][NEUTRAL] And I wasn't quite sure if um.
[CUSTOMER][NEGATIVE] I was calling an insurance company or not because I couldn't get the number to bring up anything online.
[AGENT][NEUTRAL] OK, um, yes, we're American Public Life. We do like supplemental and secondary policies. Do you have the, um, last name of the patient or social?
[CUSTOMER][NEUTRAL] Um, I've got the last name and a member ID.
[AGENT][NEUTRAL] OK, what's the member ID?
[CUSTOMER][NEUTRAL] 022461746
[AGENT][NEUTRAL] The patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII], uh, [PII].
[AGENT][NEUTRAL] OK, I didn't pull anything up up under that policy number. Let me look it up by name. [PII]
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let me see if this is it.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, and you said 5796, is that right?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so yes, I show that he is active and effective [PII].
[AGENT][NEUTRAL] Um, this is a secondary policy, so let me see if I have his primary.
[AGENT][NEUTRAL] Uh, show his primary insurance is through community care.
[CUSTOMER][NEUTRAL] Community care? OK. Yeah, I don't have that listed on here.
[AGENT][NEUTRAL] I don't have a policy number for that, but that's what we have listed as his primary because he has to have that for this policy, so.
[AGENT][NEUTRAL] Um, let me see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And is this outpatient physical therapy?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, it's not a guarantee of payment basic outline of the policy.
[AGENT][NEUTRAL] Uh, let's see, so for his policy.
[AGENT][NEUTRAL] This is gonna pick up after primary processes the claim, anything that's left over, deductible, co-insurance, co-pay.
[AGENT][NEUTRAL] Um, and it will pay.
[AGENT][NEUTRAL] It's gonna pay $2500 per covered person per calendar year, so it'll pay 100% up to that dollar maximum.
[CUSTOMER][NEUTRAL] OK, so it's got more of like a um money limit.
[CUSTOMER][NEUTRAL] But not like a visit limit.
[AGENT][NEUTRAL] Correct, yeah, it's, it's just like it's a gap plan so it'll fill in what's left over from the primary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, is prior authorization required through y'all?
[AGENT][NEUTRAL] No, it's not.
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] OK, and then is this something that
[CUSTOMER][NEUTRAL] We send to you or does their primary insurance send it to you?
[AGENT][NEUTRAL] Um, so a lot of, uh, providers will file on for the patient. So once you receive the primary EOB from community care, you can file the claim with us along with the primary EOB and then we'll pay you if there's assignment of benefits. So we would pay 100% of what's left over up to that $2500 mark.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's just up to you if you file for your patients or not for the secondary stuff.
[CUSTOMER][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Otherwise they can file and then we would reimburse them.
[CUSTOMER][NEUTRAL] Yeah, I believe we do that, um.
[CUSTOMER][NEUTRAL] We've just got somebody else that handles the secondary in the office. I'm not usually the one that messes with that.
[CUSTOMER][NEUTRAL] Um, let's see, what is y'all's, uh, claims payer ID number and address?
[AGENT][NEUTRAL] Um, our, our payer ID is 60801.
[AGENT][NEUTRAL] And our mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Zip code [PII].
[CUSTOMER][NEUTRAL] OK. And then do you have a fax number?
[AGENT][NEUTRAL] Our fax number is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK, um, and then.
[CUSTOMER][NEUTRAL] Through y'all, uh, what is their ID number if it wasn't that number that.
[AGENT][NEUTRAL] Um, it's
[CUSTOMER][NEUTRAL] That I was that I gave.
[AGENT][NEUTRAL] 0246, did you give me that number? 02461746.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so they must have just had too many twos in here because I've got 022.
[AGENT][NEUTRAL] Oh, and can I get a good callback number for you [PII], for our records?
[CUSTOMER][NEUTRAL] Yes. [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Let me see. I'm trying to make sure I got.
[CUSTOMER][NEUTRAL] All the information that I need to make sure.
[CUSTOMER][NEUTRAL] To pass along here.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] OK. I think I've got it all.
[CUSTOMER][NEUTRAL] Would you happen to have a call reference number for our call?
[AGENT][NEUTRAL] A call reference number is just my name, [PII]. First initial to last name [PII], and today's date.
[CUSTOMER][POSITIVE] All right. I do appreciate your help today, [PII].
[AGENT][POSITIVE] OK, thanks for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] Thanks you too.