AccountId: 011433970860
ContactId: 82c882f3-5281-4d28-924e-36b001df67db
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 328970 ms
Total Talk Time (AGENT): 131577 ms
Total Talk Time (CUSTOMER): 160414 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/82c882f3-5281-4d28-924e-36b001df67db_20250224T21:06_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Good afternoon. Uh, my name is [PII]. I have gap insurance with you all. Um, I just had surgery [PII], and I've been going to physical therapy and I did use my GAP, uh, but I just don't, I, I don't, I don't know the process of getting my reimbursement for the, the money that I've already put that I put in.
[AGENT][NEUTRAL] OK, uh, Mr. [PII], what is your policy number, please?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEGATIVE] Uh, unfortunately, I don't have my card on me. I don't know if you can check me through a social or my birthday.
[AGENT][NEUTRAL] Oh, what's your social?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] just
[AGENT][NEUTRAL] OK. And what was your last name?
[CUSTOMER][NEUTRAL] Over there.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh she.
[AGENT][NEUTRAL] And verify your date of birth and mailing address for me, please.
[CUSTOMER][NEUTRAL] You got it [PII] and mailing address is [PII].
[AGENT][NEUTRAL] OK. Um, what, well, with this policy is secondary, uh, what it does, it helps with primary insurance, deductible, co-pay or or co-insurance, uh, but what we will need is the itemized billing, showing diagnosis and procedure codes and the primary EOB or explanation of benefits for the dates of service you're filing for.
[CUSTOMER][POSITIVE] OK, perfect. So it's the itemized um summary.
[AGENT][NEUTRAL] Itemized bill showing diagnosis and procedure codes.
[CUSTOMER][NEUTRAL] OK, one second, I'm writing this down. Um, itemized bill summary, which shows
[CUSTOMER][NEUTRAL] Procedure
[AGENT][NEUTRAL] Procedure and diagnosis code.
[CUSTOMER][NEUTRAL] Diagnosed.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Code. And then
[AGENT][NEUTRAL] And the primary explanation of benefits for the dates you're filing for.
[CUSTOMER][NEUTRAL] Primary EOB. OK. And then is this, would these two things be able to get from the surgeon, or is that something I have to go to the emergency room and stuff like that?
[AGENT][NEUTRAL] Um, for the billing, you can get from the surgeon. You say you had a surgery and the explanation of benefits you will get from your primary insurance carrier.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Very.
[AGENT][NEUTRAL] And that EOB would be specifically for the date of service you're filing for.
[CUSTOMER][NEUTRAL] Insurance.
[CUSTOMER][POSITIVE] OK. And then this will be from the surgeon. Perfect. And then um once I have those with me, I go ahead and call you guys back so I can send an email or fax somewhat, somehow?
[AGENT][NEUTRAL] Alright, you can mail it or fax it to our office.
[CUSTOMER][NEUTRAL] Mail it or fax.
[AGENT][NEUTRAL] And I, it looks like [PII] is the policyholder. Uh, we do have an online service center to where she can set up an account on the online service center to where you can submit claims that way as well.
[CUSTOMER][NEUTRAL] 46.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. And um may I please have that?
[AGENT][NEUTRAL] It's secured, [PII].
[CUSTOMER][NEUTRAL] A [PII].
[AGENT][NEUTRAL] Mhm. [PII]. Yes, sir.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] OK, perfect. Um, fantastic. And then,
[CUSTOMER][NEUTRAL] Use, that's, that's, I guess that's all I need. I'm, I'll start working on that and getting that from the surgeon and from the insurance company. And um and then that's how I'll start the claim. Another question, um, does it cover physical therapy?
[AGENT][NEUTRAL] Uh, let me double check and see.
[CUSTOMER][NEGATIVE] Because for example, my insurance company doesn't, is out of, um, my, uh, physical therapist is out of network. So I'm paying $60 every time I go, but it's starting to get a little hefty.
[AGENT][NEUTRAL] Um, sure, it's adding up for sure, but no, uh, physical therapy is covered, but it, um, so did your primary just flat out say it's not covered or is this in a
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] No, to be honest, the one that's, it was the physical therapist that told me that that I wasn't covered cause we were out of network. Is that something I should call my insurance company and, and try and uh
[AGENT][NEUTRAL] The position is on the network.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Get that approved.
[AGENT][NEUTRAL] Yes, sir, because in order for us to cover a secondary, it has to be one covered by your primary.
[AGENT][NEUTRAL] It has to be processed by your primary.
[CUSTOMER][POSITIVE] For the physical therapy. Got it. OK. OK. Thank you so much. You've been very helpful. I appreciate it.
[AGENT][NEUTRAL] Yes, sir.
[AGENT][POSITIVE] Oh, you're welcome and thank you for calling APL, Mr. [PII]. Have a great day.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] You have, you too. Bye-bye.
[AGENT][NEUTRAL] Bye.