AccountId: 011433970860
ContactId: 6fca9d0a-17f3-4b46-8cb5-c074917a8cfb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 463040 ms
Total Talk Time (AGENT): 219062 ms
Total Talk Time (CUSTOMER): 210580 ms
Interruptions: 3
Overall Sentiment: AGENT=0.3, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/6fca9d0a-17f3-4b46-8cb5-c074917a8cfb_20250320T18:39_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] I'm so sorry, what was your name again?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] Hi Miss, um, my name is [PII]. I'm calling from Pinecrest Physical Therapy, and, um, I have a patient that, um, we're wondering if her coverage will cover her co-pay, her remaining balance. I'm not sure if you're able to pull up her, um, coverage for me.
[AGENT][NEUTRAL] OK, sure. I can assist you with benefits, and this is gonna be a copay for the office visit or is it a procedure done in the office?
[CUSTOMER][POSITIVE] It's a um physical therapy visit that she had. She's had several. Thank you so much.
[AGENT][NEUTRAL] The therapy, OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're welcome. And may I have your name again and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII] last initial [PII] for [PII], telephone number is area code [PII].
[AGENT][NEUTRAL] OK, thank you. Um let me pull.
[AGENT][NEUTRAL] Really quick. OK, may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, policy number is going to be 01578530 M as in Mary, L as in Larry 8.
[AGENT][NEUTRAL] Mm, OK. And what's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yes, it's [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Does she go by any other last names besides [PII]?
[CUSTOMER][NEUTRAL] Let me see here, um, probably the last guess.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Do you have the copy of the card?
[CUSTOMER][NEUTRAL] Yes, uh, well, um, all I have is the husband's.
[CUSTOMER][NEUTRAL] Insurance which would be [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, thank you, Ms. [PII]. Yeah, yeah, she's on my nose. OK. Uh, let me go ahead and check and see if this policy covers physical therapy.
[CUSTOMER][NEUTRAL] Probably [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] I'm gonna go through the whole alphabet.
[AGENT][NEUTRAL] I know
[AGENT][NEUTRAL] Oh, just, yeah, that's what happens when you don't change your life.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Uh yeah. OK.
[CUSTOMER][NEUTRAL] Got us wondering which one is it? Which one of the three?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK let me check this benefits really quick. And before I give you any benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And let's see. You're welcome. OK so this is one of our secondary supplemental plan to the major medical. And see, this one does cover physical therapy, so that is subject to the outpatient maximum of 1250 per covered person per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And you said that was 1000?
[AGENT][NEUTRAL] 250 per year.
[CUSTOMER][NEUTRAL] 250.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Per year per patient.
[AGENT][NEUTRAL] Correct, yes. And this is for any outpatient service, including physical therapy.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, she has not used her benefits, so she still have the full amount available.
[CUSTOMER][NEUTRAL] OK, so I can go ahead and, uh, forward the, uh, data service because she has, let's see, uh, 12345.
[AGENT][NEUTRAL] Mhm. Are they for [PII] or are they for [PII]?
[CUSTOMER][NEUTRAL] 2025.
[AGENT][NEUTRAL] Um, yes, mhm, yeah, she has not used her benefit as of today, so yes, you can forward those over to us with the explanation of benefits from the primary insurance attached to it.
[CUSTOMER][NEUTRAL] OK, so you would need like um primary EOB?
[AGENT][NEUTRAL] Mhm, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And did you need um treatment notes um as well?
[AGENT][NEUTRAL] No, we just need um the 1500 form um and the primary ELB mhm.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Just the primary it'll be.
[CUSTOMER][NEUTRAL] OK, and can these be uh faxed or do you guys accept um paper claims?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You can either fax it or mail it, um, since we need the EOB attached to it, it cannot be sent electronically because usually you cannot attach an EOB to it, but um you can send it by fax or mail. Uh, the fax number is 1-877.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 365.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 942 3 uh-huh, 36594.
[CUSTOMER][NEUTRAL] I'm sorry, 365?
[AGENT][NEUTRAL] 23.
[CUSTOMER][NEUTRAL] OK, and that was [PII] correct?
[AGENT][NEUTRAL] Yes, that is correct, yes. And let me give you the address. I'm not sure if you have it, but the address is [PII].
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] [PII], [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] And let me see.
[CUSTOMER][NEUTRAL] I'm trying to think what else.
[CUSTOMER][NEUTRAL] So I can just go ahead and fax the the claim and the uh EOB, the primary EOB.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And let's see here I think that would be it.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, so that, that would be, that would be it. That's, I think basically have everything covered, um, so, can I go ahead and get a reference number for the call?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We don't have reference numbers as well, so you can use my name in today's date if you will. Do you need the spelling of my name or any other information?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] No, that was just is your first name [PII].
[AGENT][NEUTRAL] So, just so, so, uh-huh.
[CUSTOMER][NEUTRAL] So, OK, I thought you were using it for short. I'm like, OK.
[AGENT][NEUTRAL] No
[CUSTOMER][POSITIVE] Sorry about that.
[AGENT][NEUTRAL] That's my full name. I know a lot of people do think that. I'm like, no, that's my name.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK perfect so I'll go ahead and um print those out right now and I can um do I put um um if I fax it is it attention to a certain department or?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Claims department.
[CUSTOMER][NEUTRAL] Just claims.
[AGENT][NEUTRAL] Mhm. Yes.
[CUSTOMER][POSITIVE] OK, perfect. OK, well thank you so very much you've answered my questions and it does take about 30 to 45 days for processing.
[AGENT][NEUTRAL] And
[AGENT][NEGATIVE] Um, no, the processing time is really short. It's 7 to 10 business days.
[CUSTOMER][POSITIVE] Oh perfect.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, perfect. Thank you so very much I appreciate your help.
[AGENT][POSITIVE] You're welcome and thank you for calling APO. Have a good afternoon, Sky.
[CUSTOMER][POSITIVE] You do as well take care.
[AGENT][POSITIVE] Thank you. You too. Mm bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.