AccountId: 011433970860
ContactId: 13233d56-22df-446d-9a38-4d5ebe220c1e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 241160 ms
Total Talk Time (AGENT): 136951 ms
Total Talk Time (CUSTOMER): 96781 ms
Interruptions: 1
Overall Sentiment: AGENT=1.9, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/13233d56-22df-446d-9a38-4d5ebe220c1e_20250428T13:08_UTC.wav
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[AGENT][NEUTRAL] Contacting APL, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I have a patient here today who presented their APL card to me and I've never used or seen one of these, so I wanted to get some information and see if it even covered the services we're providing.
[AGENT][POSITIVE] Of course, I can help with that with him.
[CUSTOMER][NEUTRAL] Uh they do have a primary insurance.
[AGENT][NEUTRAL] Right, um, and with whom am I speaking, please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] [PII], thank you. And what's that policy number that we're looking at today?
[CUSTOMER][NEUTRAL] It is 02611805.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] I can certainly help with eligibility and benefits. And what is the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Um, I get that. I don't have that. Hold on, I know it's [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][NEUTRAL] [PII]. OK, let's just check here.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you. The, this is a secondary gap insurance and um it does cover uh inpatient and outpatient services. The thing is, is that [PII] isn't listed on here. Now, uh what date of birth did you have for [PII] again? Do you mind telling me that? I apologize. I just need to run.
[CUSTOMER][NEUTRAL] He is brand new.
[CUSTOMER][NEUTRAL] So it is [PII], um, from what I understand they got new insurance on [PII], so maybe.
[AGENT][POSITIVE] Oh, wow. OK.
[AGENT][NEUTRAL] Oh my, OK.
[AGENT][NEUTRAL] Yes, they need to add him to that. I'm sure they.
[CUSTOMER][NEUTRAL] They got new insurance and then this policy.
[AGENT][NEUTRAL] Yeah, I'm sure that they meant to add him. They've got their other child. Um, so, uh, when it, it, what he, he, what, uh, Mr. [PII] needs to do is he needs to contact his, his, uh, um, employer. We do need to have, uh, the baby added, um, and they can and, you know, that they can figure that out. Um, what type of service is this so that I can tell you after he gets the child added.
[CUSTOMER][POSITIVE] What the yeah that'd be great um it's for physical therapy.
[AGENT][NEUTRAL] OK, yes. So what we will do is we will pick up the deductible, co-payment or co-insurance or physical therapy up to $6000 per calendar year. That is just a verification of those benefits, not a guarantee of payment. So [PII], once they get uh um Carter uh on there, um.
[AGENT][POSITIVE] That will be great. That is what we'll end up doing. So you'll file through their major medical first, and then you'll file through us. But uh yes, it certainly is covered. It's just that the child's not on there yet, so that, that's something that, that, that needs to be done.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you guys, I'm looking at their cards now oh there's the electronic payer ID that's what I was looking for, OK.
[CUSTOMER][NEUTRAL] Alright, um, so I will let her know then that he's out added and they need to call, um, so I just bill you and then you guys send the check for the, I guess out of pocket portion for the patient portion, correct? OK.
[AGENT][POSITIVE] Absolutely. That's, that's correct. That, that's what we do.
[CUSTOMER][NEUTRAL] OK, well then I will let her know and how long do you guys process like does it take typically to process just so I can keep an eye and check status.
[AGENT][NEUTRAL] It usually takes
[AGENT][POSITIVE] Absolutely. It takes about 8 to 10 business days once we receive the uh the claim.
[AGENT][NEUTRAL] Um, now, is there anything else that I can take? Would you like our mailing address? We have an online service center which you can get your claim to us much faster, and that should be listed on the card. It's um [PII]. Uh, so we, you can go online, you can fax it, you can mail it, um, but the online service center it just makes it that much faster.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh yeah I see it. [PII] yep I see it.
[AGENT][NEUTRAL] That's it, yeah.
[CUSTOMER][POSITIVE] OK perfect and then I have the address and payer ID on the cards too so that's good.
[AGENT][POSITIVE] OK, great. Is there anything else at all that I can help with?
[CUSTOMER][NEUTRAL] No, I think that is all.
[AGENT][POSITIVE] OK, well thank you for contacting API you have a very good day.