AccountId: 011433970860
ContactId: 71cef319-39a6-476a-9024-ec70783c6b5f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 424190 ms
Total Talk Time (AGENT): 100026 ms
Total Talk Time (CUSTOMER): 202678 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/71cef319-39a6-476a-9024-ec70783c6b5f_20250620T16:26_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. My name is [PII]
[CUSTOMER][NEUTRAL] Um, I'm calling regard, um, regarding the patient. Um, she has an appointment with us at, um, here in the clinic for the physical therapy.
[CUSTOMER][NEUTRAL] So, uh, with the information you need from me, so I need to check the benefits.
[AGENT][NEUTRAL] OK, I can help you with benefits, [PII]. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] And policy number for that patient?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And yeah.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Do you have the policy number for the patient?
[CUSTOMER][NEUTRAL] Um, policy number, um.
[CUSTOMER][NEUTRAL] Oh, the payer ID, I mean, the hm.
[CUSTOMER][NEUTRAL] When you say policy number is the payer ID or?
[AGENT][NEUTRAL] No, the, the payer ID is where you file claims. It'd be the policy er certificate number.
[AGENT][NEUTRAL] Policy certification number?
[CUSTOMER][NEUTRAL] Oh yes, yes, I have it. It's 02.
[CUSTOMER][NEUTRAL] 44 3 492.
[CUSTOMER][NEUTRAL] M like ML8.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[CUSTOMER][NEUTRAL] have
[AGENT][NEUTRAL] And date of birth?
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] No, I, I call it because the daughter wants to do the physical therapy and [PII] is the father. You know, you need me to give you the date of birth of the daughter?
[AGENT][NEUTRAL] Yes, and what was her name?
[CUSTOMER][NEUTRAL] Because it's searching for the physical therapy, but
[CUSTOMER][NEUTRAL] Yes, the name is [PII].
[AGENT][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] [PII]. [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK. And, and this was for outpatient physical therapy?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, it's not a guarantee of payment, basic outline of the policy. Uh, for this policy, it pays a max of $6000 per covered person per calendar year. This is a secondary policy, so this will pay after primary processes the claim. It'll pick up on deductible, co-insurance, co-pay.
[AGENT][NEUTRAL] Up to 6000.
[CUSTOMER][NEUTRAL] I don't, I don't understand. Can you repeat, please?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So this is a secondary policy?
[AGENT][NEUTRAL] So their primary
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah, so this will pay a max of 6000 per calendar year.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, so she has a $6000 deductible with United Healthcare with the primary insurance.
[CUSTOMER][NEUTRAL] So you will be covered her after she made deductible for the primary one?
[AGENT][NEUTRAL] No, wait, when we received the EOB from primary, whatever was applied to the deductible, we pay 100% up to $6000.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so what that means, um.
[CUSTOMER][NEUTRAL] With the um the primary insurance not covering yet now because she don't meet ductible yet. That means she has to pay. But she gave me a uni just secondary uh your secondary insurance. So you will, you will cover them for the physical therapy?
[AGENT][NEUTRAL] Yes, we pay 100% up to $6000 per calendar year.
[CUSTOMER][NEUTRAL] Oh, OK. Um, so what's happened now and she have to pay now and you will be, you will refund them? What works?
[AGENT][NEUTRAL] It's up to you how you want to bill the patient. I don't, uh, I mean.
[CUSTOMER][NEUTRAL] OK. Give, give me one second, please. Give me 1 2nd.
[AGENT][NEUTRAL] Those providers file.
[CUSTOMER][NEUTRAL] OK, give me one second. Let me ask the doctor, stay on the line, please. Thank you.
[CUSTOMER][NEUTRAL] Thank you very much. So, um, so we'll put um the, this insurance and to the, the, um, patient form for the billing can, um, did it for the billing after. So you confirm me you will pay for the, for this patient, right?
[AGENT][NEUTRAL] Yes, as long as when we receive the claim, the policy is still active, yes.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] OK, thank you very much. Um, even if we're not in network with you because the first time I have this insurance, I just wanted to make sure.
[AGENT][NEUTRAL] Yeah, we don't have a network no network applies.
[CUSTOMER][NEUTRAL] OK, no thank you very much. Can I have your name please?
[AGENT][NEUTRAL] My name is [PII], first [PII] name, [PII].
[CUSTOMER][NEUTRAL] You say [PII]?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, and the initial last name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] OK. [PII] data. Can I have the response of the call, please?
[AGENT][NEUTRAL] The reference number is my name and today's date.
[CUSTOMER][NEUTRAL] Um, say again, please?
[AGENT][NEUTRAL] Were you asking for the reference number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] It's my name, [PII], and today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um [PII]
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Like that and D.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Like Delta, and today is 0620-2025.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank you very much. I appreciate your help. Have a great day. Bye.
[AGENT][POSITIVE] Thank you for calling APL you too, bye bye.