AccountId: 011433970860
ContactId: 651d4f9b-bcf3-4b2c-bcfb-bf3d57e40782
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 235600 ms
Total Talk Time (AGENT): 121598 ms
Total Talk Time (CUSTOMER): 74711 ms
Interruptions: 2
Overall Sentiment: AGENT=1.8, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/651d4f9b-bcf3-4b2c-bcfb-bf3d57e40782_20250123T20:53_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from orthopedic rehabilitation specialist. Um, a patient has a, uh, APL as their secondary insurance, and I'm just wondering if it covers anything when it comes to physical therapy done in an office setting.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and you say you're needing to get eligibility and benefit information for a member, is that correct?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] Uh, my callback number is [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number, please?
[CUSTOMER][NEUTRAL] I'm sorry, what was that?
[AGENT][NEUTRAL] What is the member's policy number?
[CUSTOMER][NEUTRAL] OK. Uh, the member's policy number is 0257.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] 5606.
[AGENT][POSITIVE] Thank you. OK.
[CUSTOMER][NEUTRAL] Um, ML 8.
[AGENT][NEUTRAL] OK, thank you, one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All 3.
[AGENT][NEUTRAL] OK, and any, any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, the patient's name is [PII], and the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so she is a subscriber on the supplemental policy and it is active with an effective date of [PII].
[AGENT][NEUTRAL] She does have an office treatment rider on her policy, [PII], and her outpatient benefit maximum is $1000 per covered person per calendar day for covered outpatient services, and there is no outpatient deductible per covered person per calendar day.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And because this is a supplement to her primary insurance, when the claim is submitted to APL for review, we must also have a copy of her primary insurance company's explanation of benefits.
[AGENT][NEUTRAL] And then once we have processed the claim with APO you should be able to check claim status.
[AGENT][NEUTRAL] For us, [PII], by going to our portal at [PII].
[CUSTOMER][NEUTRAL] OK, so she has up to $1000 per covered person per calendar date.
[AGENT][NEUTRAL] For covered outpatient services, yes ma'am.
[CUSTOMER][NEUTRAL] OK, um, alright, so.
[CUSTOMER][NEUTRAL] I'm assuming we just we wouldn't bill the patient we would just, um, bill the insurances and then.
[AGENT][NEUTRAL] Well, we can't deter yes ma'am, we can't determine that you would obviously, you would follow it first with our primary since we have to have a copy of their explanation of benefits for review.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, alright, um, OK, I believe that was everything I needed thank you. um, could I just get a reference?
[AGENT][POSITIVE] OK. Well, you're certainly welcome. Sure. You will use my, my name that I gave you along with today's date.
[CUSTOMER][NEUTRAL] Uh, sorry.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] OK. Well, you are very welcome. So if that's all then that I can help you with, [PII]. Thank you again for calling APL and I hope you have a nice evening.
[CUSTOMER][POSITIVE] You too have a great day.
[AGENT][POSITIVE] Thank you. You too. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.