AccountId: 011433970860
ContactId: 69cd350a-c152-4c25-9e43-d6ff6d53641b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 305000 ms
Total Talk Time (AGENT): 106447 ms
Total Talk Time (CUSTOMER): 130893 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/69cd350a-c152-4c25-9e43-d6ff6d53641b_20250409T12:43_UTC.wav
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[AGENT][NEUTRAL] For calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, I have a, I have a question uh about uh the gap uh insurance. Um, I have a physical therapy, uh, appointment this morning.
[CUSTOMER][NEUTRAL] And I just wanted to know if the, the gap covers, uh, I mean, the, the, the extra expense, I guess.
[AGENT][NEUTRAL] May I have your policy number and I'll pull up your policy benefits.
[CUSTOMER][NEUTRAL] Uh, that's the ID.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 60801.
[AGENT][NEUTRAL] That is the payer ID. You should have an inpatient or outpatient cert number.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, I have uh outpatient is 02556021 M.
[CUSTOMER][NEUTRAL] L. 8.
[AGENT][POSITIVE] Thank you. May I have your name and a good callback number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. Can you verify your date of birth, your mailing address, and your email, please?
[CUSTOMER][NEUTRAL] [PII] D. [PII]. [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. Please be advised that verification of coverage does not guarantee the payment of a claim. So let me get this pulled up.
[AGENT][NEUTRAL] It will pick up your co-pays, your co-insurance and or deductibles up to the benefit amount. So for the physical therapy,
[AGENT][NEUTRAL] Just make sure it's allowed under this plan.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It will fall under the outpatient calendar year benefit amount of $7150.
[AGENT][NEUTRAL] So it is covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, so does that mean I pay and then I just submit the claim to you to APL?
[AGENT][NEUTRAL] What, what you can do is at time of service, give them this card and tell them to file with the secondary as well as your primary.
[CUSTOMER][NEUTRAL] OK, I, I seem to be telling them that yesterday on the phone and they said, they said no, usually I have to pay and then I have to file a claim. Uh, I will try again today. Uh, that was over the phone, so maybe in person would be different, uh, so that's why I'm, that's the reason of my call. I wasn't too sure.
[CUSTOMER][NEUTRAL] Uh, so I'll bring both cards and, and see how that, uh, if that's gonna, she, she seemed to be insistent on the phone that no I would have to pay and then I would have to submit myself.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and if you have to submit it yourself, you will need an itemized bill from that provider and your primary insurance explanation of benefits along with a claim form to submit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so let me just write that down before I forget, so I would need for [PII]
[CUSTOMER][NEUTRAL] So explanation.
[CUSTOMER][NEUTRAL] Of primary.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Benefits.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEGATIVE] And the first thing you told me was a itemized itemized.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Itemized bill from that provider.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, I'll do that.
[AGENT][NEUTRAL] And then your claim form.
[CUSTOMER][NEUTRAL] And and uh since we're on
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And fill out the claim form online, right?
[AGENT][POSITIVE] Correct, yes, sir.
[CUSTOMER][NEUTRAL] And uh can you please verify for [PII]?
[AGENT][NEUTRAL] Let's see if it's performed in the office. It will also fall under your outpatient calendar year benefit amount.
[AGENT][NEUTRAL] If it's performed in the doctor's office.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, one more thing, sorry about that, uh, uh, massages, massage therapy.
[AGENT][NEUTRAL] Would it be performed in the doctor's office?
[CUSTOMER][NEUTRAL] It has to, yes.
[AGENT][NEUTRAL] Yes, it will fall under your office treatment.
[CUSTOMER][POSITIVE] OK, OK, great.
[CUSTOMER][POSITIVE] Great I appreciate it thank you for the help.
[AGENT][POSITIVE] You're so welcome, [PII], and thank you for calling American Public Life. Have a great day.
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][NEUTRAL] Bye-bye.