AccountId: 011433970860
ContactId: 786d3ea4-cffb-4ed8-a137-405b01e42314
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 625619 ms
Total Talk Time (AGENT): 281828 ms
Total Talk Time (CUSTOMER): 122439 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=-1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/786d3ea4-cffb-4ed8-a137-405b01e42314_20250305T18:46_UTC.wav
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[AGENT][NEUTRAL] Contacting APR. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I am calling from Kyo Autism Therapy. So we have a client that has APL as a primary insurance and has a secondary insurance. We understand that the APL plan that this family has is only for, let me look at the exact wording, it's like only for uh.
[CUSTOMER][NEUTRAL] Unlimited policy for office visit benefits exclusively.
[AGENT][NEUTRAL] Oh, OK. Would you
[AGENT][NEUTRAL] Well, do you have their policy number, [PII]? I'd be glad to look that up and I can tell you exactly what their benefits are.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Sure, their policy number is 024.
[CUSTOMER][NEUTRAL] 581-69
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Um, the insured is [PII].
[CUSTOMER][NEUTRAL] The patient and which we're providing services for their child [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK, thank you. Is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] OK, I'm gonna look this up. I'll be right back. Excuse me just one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] Uh, yeah, this is gonna take long.
[AGENT][NEUTRAL] And I thought I'll call you back, OK?
[AGENT][NEUTRAL] OK, well then, yes, and then uh when you when
[AGENT][POSITIVE] Work out, but yes, obviously you can bring the children over and if anything else is going and I'm also finding some other things to start, uh, reorganizing your room and you you didn't tell me what you think.
[AGENT][NEUTRAL] And um
[AGENT][NEUTRAL] And then uh I am taking the girls to round one, but I.
[AGENT][NEUTRAL] Stuffed animals are often, but I'm thinking too, you know, because [PII] uh has her.
[AGENT][NEUTRAL] I'm thinking I'm telling [PII] that.
[AGENT][NEUTRAL] on the way. I've got these uh vacuum pack bags.
[AGENT][NEUTRAL] And um I've got room in [PII]'s closet. [PII].
[AGENT][NEUTRAL] With that, um, and so she.
[AGENT][NEUTRAL] Care and so it's uh you know.
[AGENT][NEUTRAL] [PII] and [PII] can play with these stuff down before they get over.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Um, I used to have, uh, animal toys and stuff.
[AGENT][NEUTRAL] house all the time, you know, dad's house.
[AGENT][POSITIVE] Which is what I know, you know, something that's what I, you know, she got such a great idea. That's why I had, I saved all these toys in that dollhouse.
[AGENT][NEUTRAL] Yeah,
[AGENT][NEUTRAL] Oh, well, you know something, you know, when you were a kid, we used to have a trunk. We used to have a trunk that we put things in in the living room, and I know that you've got some sort of a toy box there, but that was another thing I'm gonna talk to you about is that, uh, you know, some place that gets it out of your.
[AGENT][NEUTRAL] their
[AGENT][NEUTRAL] Um
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Well, you
[AGENT][POSITIVE] Well, why don't we look at the, you know, if we can get it off of a firm or something like that, maybe we can find another one of the bees that, you know, that's, that's a great idea, and then you can, I think if you, I think if you get those things out of your living room.
[AGENT][NEUTRAL] I know that it piled up along the wall and that may be great for [PII], but um I think.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Something where you can uh.
[AGENT][NEUTRAL] Uh, you know, use the space, you know, you don't have that, you're, you're walking right past over.
[AGENT][POSITIVE] Maybe that will help with you too and I was also finding some of these large uh baskets that we could put your your blankets in or something maybe organize your.
[AGENT][NEUTRAL] Oh, I
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh, OK, so OK, I get it so.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Yeah, yeah, yeah, I get it, yeah, it's that's I know.
[AGENT][NEUTRAL] Listen, I'm gonna have to go, but I'll talk to you. I'll talk to you later, OK?
[AGENT][POSITIVE] Lovely Prince.
[AGENT][POSITIVE] Love you, baby.
[AGENT][NEUTRAL] But
[AGENT][NEUTRAL] [PII], thank you. I, I have pulled up the policy. Um, now, you were looking for physical therapy or looking for office visits?
[CUSTOMER][NEUTRAL] I'm looking for ABA therapy.
[AGENT][NEUTRAL] OK, let me just see what we have here. Now this is a hospital indemnity policy and what it does is it it pays a limited benefit for very specific services. Let me just see if that's even listed on here.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, because I don't see that it is, yeah.
[AGENT][NEUTRAL] So there's an intensive care, there's.
[AGENT][NEUTRAL] Other things.
[CUSTOMER][NEUTRAL] It's a behavioral health.
[AGENT][NEUTRAL] I
[CUSTOMER][NEUTRAL] I said I could be.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah, I understand. I understand because this is mostly for hospital. This is, so what we have is intensive care. We have hospital, we have surgery. There's no benefit at all for anything like that. Um, so it's not going to have any, any sort of benefits for that type of service, uh, just because it's really just for um for the hospital.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Services, not uh not anything to do with behavioral health or offices.
[CUSTOMER][NEUTRAL] OK, then, um.
[CUSTOMER][NEUTRAL] To me it sounds like this can be a primary insurance, is that correct?
[AGENT][NEUTRAL] They might, they might have primary insurance.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] See.
[AGENT][NEUTRAL] Because this is, this is not primary insurance at all. Let's see.
[AGENT][NEUTRAL] Uh, looks like he has Aetna, perhaps, um.
[AGENT][NEUTRAL] That might be the way to go in.
[AGENT][NEUTRAL] Possible that that's available to him.
[AGENT][POSITIVE] And I apologize, it just give me a second here.
[CUSTOMER][POSITIVE] No, this is helpful. I appreciate it.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] You know, he doesn't have it, no.
[AGENT][NEUTRAL] I don't know whether it's uh, it may be, it may be available to him, but I'm not seeing that he's got it, or that it hasn't been reported to us. Um, so it looks like this is the only thing that he has that I am aware of.
[AGENT][NEUTRAL] Uh, so, uh, perhaps, uh, [PII] can tell you whether he has something else because it's, I just don't, uh, I don't show anything else other than this.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, what what we're trying to do is we do know that the child has a secondary insurance plan that's Medicaid, but in order for us to build that we have to receive a denial from the primary. And so is there somewhere that we can send our authorization request to to essentially gain that denial, given that we know that the service isn't gonna be approved by APL.
[AGENT][NEUTRAL] Absolutely, yes, it's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Sorry, can you repeat that one more time for me? Sorry about that.
[AGENT][NEUTRAL] Yes, of course, it's, it's, no, quite all right, Morgan at [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That is in [PII] City, [PII], and our zip code.
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And you can uh
[AGENT][POSITIVE] You can send that to us and what we will do is we will be glad to, to look at that.
[AGENT][NEUTRAL] And uh we can uh we can send back a rejection and then you can determine what you want to do at that point.
[CUSTOMER][NEUTRAL] OK, do you have the option for any fax or emails off request or is it exclusive to mail?
[AGENT][NEUTRAL] Oh no, our fax number is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect, we will then fax it there and is this a good number to call back on if we have any questions?
[AGENT][POSITIVE] Yes, absolutely.
[CUSTOMER][POSITIVE] Amazing, thank you so much. I appreciate your support.
[AGENT][POSITIVE] Well, thank you for contacting AT have a good day.