AccountId: 011433970860
ContactId: 2bda4c3f-634c-497d-a4c4-10b403d8daaf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 467589 ms
Total Talk Time (AGENT): 143042 ms
Total Talk Time (CUSTOMER): 152713 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/18/2bda4c3f-634c-497d-a4c4-10b403d8daaf_20250418T18:40_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] A
[CUSTOMER][NEUTRAL] Yeah, hi, [PII]. My first name is [PII]. It is to my last [PII]. I'm from COA Health Services Incorporated and I'm looking for patients benefits and eligibility.
[AGENT][POSITIVE] OK, and what was your first name again? I'm so sorry.
[CUSTOMER][POSITIVE] That's [PII]
[CUSTOMER][NEUTRAL] [PII] to my last [PII].
[AGENT][POSITIVE] Oh, sorry. OK, uh, thank you, [PII]. Um, I can help you with benefits and eligibility. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Sure. That's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I have a benefit 3 number. Is that the policy number?
[AGENT][NEUTRAL] Yes, it should be.
[CUSTOMER][NEUTRAL] OK. For outpatient benefit cert number, it's gonna be 01881548 M as in Mike, L as in love, number 8.
[AGENT][NEUTRAL] And the patient name and date of birth?
[AGENT][NEUTRAL] Um, do you have the patient name and date of birth?
[CUSTOMER][NEUTRAL] Oh, I was in the mute. Sorry about that. The patient name and date of birth.
[CUSTOMER][NEUTRAL] The date of birth would be [PII].
[CUSTOMER][NEUTRAL] And the patient name would be [PII].
[AGENT][NEUTRAL] OK, it looks like this policy is terminated, but let me look up and see if there's a current policy.
[CUSTOMER][NEUTRAL] You got it?
[CUSTOMER][NEUTRAL] No, actually, I have a date of service with me. I have a date of service that's [PII].
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, this policy terminated [PII]. Let me look for a different policy.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, got a more recent policy and you're checking on claim status?
[CUSTOMER][NEUTRAL] Now, I'm looking for the benefits since we have never submitted the claims to APL, so we are going to submit the one if the patient is active or not for the date of service.
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Yes, the policy, let me give you the correct policy number.
[AGENT][NEUTRAL] Are you ready?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 2473446
[AGENT][POSITIVE] Uh, this policy is effective, yes.
[CUSTOMER][NEUTRAL] That's it.
[AGENT][NEUTRAL] This policy is effective [PII], and it's currently active, no term date.
[AGENT][NEUTRAL] And this is for outpatient benefits, is that correct?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yeah, you're right.
[AGENT][NEUTRAL] Not a guarantee of payment, basic outline of the policy.
[AGENT][NEUTRAL] Um, for their outpatient benefits, they have a $300 per covered person per calendar day benefit payable.
[CUSTOMER][NEUTRAL] For physical therapy?
[AGENT][POSITIVE] Uh, for physical therapy, yes, that's correct.
[CUSTOMER][NEUTRAL] OK. And before that, just bear with me, OK? So let me.
[CUSTOMER][NEUTRAL] Confirm the member ID to you. Let me repeat it back to you again. I got 2473446.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] And there is no, you know, there is no alphabetics, right? There is full of numerics, right?
[AGENT][NEUTRAL] Yeah, it's just numeric, yes.
[CUSTOMER][POSITIVE] OK, I appreciate it. And, OK, so.
[CUSTOMER][NEUTRAL] Patient is covered for physical therapy, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Are you guys are acting as a secondary?
[AGENT][NEUTRAL] Yes, we are secondary. So when filing the claim, we need the primary explanation of benefits.
[CUSTOMER][NEUTRAL] So, physical therapy services will be covered at 100% each and there is no patient responsibility. Is that what you mean?
[AGENT][NEUTRAL] Um, I, we don't determine patient responsibility, so basically after a primary processes the claim, we will potentially pick up to up to $300 per calendar day for physical therapy services.
[CUSTOMER][NEUTRAL] So $300 per calendar day.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Are you there?
[CUSTOMER][NEUTRAL] Yeah, I'm still with you. And you guys are started acting as a secondary starting from the effective date for [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. And let me confirm the client's permission address to you. That's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] No, that's an old address. So our address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] What will be the time the fun will be?
[AGENT][NEGATIVE] There's no timely filing limit.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] We can submit whenever we like.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Do you have a fax number or epayer ID?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, the fax number is [PII].
[AGENT][NEUTRAL] And then our payer ID is 60801.
[CUSTOMER][POSITIVE] Appreciate it.
[CUSTOMER][NEUTRAL] Can I have the uh reference number?
[AGENT][NEUTRAL] Uh, it's just my name, [PII], first initial to last name, [PII], and today's date.
[AGENT][NEUTRAL] Can I help with anything else today?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Uh [PII]
[CUSTOMER][POSITIVE] [PII] OK. Nothing. Thank you so much, definitely.
[AGENT][NEUTRAL] Yeah. Mhm.
[AGENT][POSITIVE] OK, well, thank you for calling APL. I hope you have a good day.
[CUSTOMER][POSITIVE] Thank you so much. You as well.
[AGENT][NEUTRAL] All right, bye.