AccountId: 011433970860
ContactId: 41cc3aff-61f0-44c0-958d-f1839de3f2b0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 231899 ms
Total Talk Time (AGENT): 134577 ms
Total Talk Time (CUSTOMER): 55279 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/24/41cc3aff-61f0-44c0-958d-f1839de3f2b0_20250624T13:09_UTC.wav
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[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hi, I'm calling from the provider's office to verify insurance coverage for a patient or physical therapy coverage for a patient.
[AGENT][POSITIVE] OK, I'll be glad to help you. Go and give me your name and the member's policy number, please.
[CUSTOMER][NEUTRAL] Yes, my name is [PII]. Policy number is 02509830.
[AGENT][NEUTRAL] Right, [PII], thank you for that information. Now while I'm pulling this up, go ahead and give me a good return telephone call number.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] All right, [PII], thank you for that information. Now, your patient's name and date of birth.
[CUSTOMER][NEUTRAL] It's [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Alright, thank you for that, [PII]. It looks like Bernice is a dependent on this medical supplemental plan. They show the original effective date is [PII]. 2 current policy is active, but I must advise that verification of coverage is not a guarantee of benefits, but
[AGENT][NEUTRAL] You did say you needed benefits for physical therapy. Is that correct?
[CUSTOMER][NEUTRAL] Correct. Yeah, I'm wondering if you guys pick up any um responsibility from the primary insurance.
[AGENT][NEUTRAL] Alrighty, let me get that benefit pack pulled up. Let's see if that is covered.
[AGENT][NEUTRAL] Give me just a moment please, ma'am.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] And of course what we are is just the medical supplemental plan. So the only thing that we would pick up and pay for for sickness and injury is anything that is applied towards patients deductible, co-pay, or co-insurance at the primary insurance carrier. Now there are physical therapy benefit here is no pre-cert.
[AGENT][NEUTRAL] No deductible, and they have an $8700 outpatient benefit here per calendar year.
[CUSTOMER][NEUTRAL] So it was $8700 max sing.
[AGENT][NEUTRAL] That, that is correct, and they've not met any of that as of today.
[CUSTOMER][NEUTRAL] Got you. OK, perfect. So, uh, for example, she does have a $60 copay with her primary insurance, so that would be something that you guys would pick up. We just send over the primary EOB in the claim form.
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] You will, we will need the actual bill with the um primary ELB when you submit your claim here to APL, yes ma'am.
[CUSTOMER][NEUTRAL] OK perfect sounds good. And then finally, if I could just confirm the mailing address or the PO box to send all claims to.
[AGENT][NEUTRAL] Yes, ma'am. Our address is to APL Claims Department, [PII].
[AGENT][NEUTRAL] And we're in [PII].
[AGENT][NEUTRAL] And our zip is [PII].
[AGENT][NEUTRAL] Is that all that I can help you with?
[CUSTOMER][POSITIVE] Awesome, perfect. And if I could have your name and a reference number.
[AGENT][NEUTRAL] I'm sorry, what was that?
[CUSTOMER][NEUTRAL] Yeah, that was all. If I could have your name and a reference number.
[AGENT][NEUTRAL] OK, yes, ma'am. Well, we don't give, right, we don't give reference numbers, but you can use my name in today's date, [PII], and my name is [PII] spelled [PII]
[CUSTOMER][NEUTRAL] Yeah, just your name and a reference.
[CUSTOMER][POSITIVE] OK, well, perfect, thank you so much for your help today.
[AGENT][POSITIVE] Yes, ma'am, and thank you for calling APO. Have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] You too. Bye-bye.