AccountId: 011433970860
ContactId: 84a22e49-f01c-4062-8144-2380ff759d8a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 259309 ms
Total Talk Time (AGENT): 143194 ms
Total Talk Time (CUSTOMER): 86263 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/84a22e49-f01c-4062-8144-2380ff759d8a_20250610T18:18_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Line. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi, I was calling to find out on my daughter's benefits.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I can help you with that. Can I get your name and a callback number, please?
[CUSTOMER][NEUTRAL] Our callback number is [PII] and my name is [PII].
[AGENT][POSITIVE] Very good. Thank you for that. And what is your policy number?
[CUSTOMER][NEUTRAL] 14793
[AGENT][NEUTRAL] Mm, OK, that wouldn't be, it would be the outpatient certificate number.
[CUSTOMER][NEUTRAL] Oh, is that the, oh, is that 60801, the payer ID?
[AGENT][NEUTRAL] No, the outpatient cer certification number or cert number, you'll have an outpatient and an inpatient.
[CUSTOMER][NEUTRAL] Let me see if I see it
[CUSTOMER][NEUTRAL] In the card I don't see that it says American public life.
[AGENT][NEUTRAL] On the car.
[CUSTOMER][NEUTRAL] It oh, outpatient. I'm sorry. Yes, you're correct. 04, I mean, I'm sorry, 02.
[CUSTOMER][NEUTRAL] 424-711 M like in [PII], L, and the number 8.
[AGENT][NEUTRAL] OK, thank you so much. And you did say you were calling, if you could just verify your date of birth, but I know your question is about your daughter.
[CUSTOMER][NEUTRAL] 521 75. I'm [PII] I'm her mom, [PII].
[AGENT][POSITIVE] Oh, OK, thank you and.
[CUSTOMER][NEUTRAL] I'm calling [PII] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and you did say you had questions about her benefits. How can I help you?
[CUSTOMER][NEUTRAL] So my question is, she's, she's going through physical therapy.
[CUSTOMER][NEUTRAL] So, can you explain to me how this insurance works to see if it's the way I think it works?
[AGENT][NEUTRAL] OK, no problem. Uh, so, um, your gap policy with us does pay secondary to your major medical and so claims would be submitted to your major medical first. Um, if there's patient responsibility, the provider would then send the claim along with your, um, the explanation of benefits from your primary to us showing what you owe, and we will pick up the balance for covered charges.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, as for the, um, physical therapy, uh, that is covered under your outpatient benefit, paying up to $5500 a calendar year. And please be advised verifying benefits is not guaranteed payment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] And do you know where she's at in regards to that?
[AGENT][NEUTRAL] Uh let me check her balance.
[AGENT][NEUTRAL] And this is for [PII], correct?
[CUSTOMER][POSITIVE] Correct, yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I show that uh [PII] at this time has met $3,857.81 of the $5550.
[CUSTOMER][NEUTRAL] All right, so I have a question. So in with her primary insurance, they covered up to 35 sessions of therapy.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's Blue Cross Blue Shield. After that, they do not cover anymore. That's how much they cover a year. She's she's already reached those 35. Does that mean that now you guys will cover the remaining?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, so also, um, if for us to cover the patient responsibility, it has to be applied to deductible, co-pay or co-insurance. So if they deny the claim, um, you know, we will no longer pay on this claim, uh, because the maximum allowed visits have been met, then we cannot consider the charges because if they're going to deny it, it won't be applied to deductible co-pay or co-insurance.
[CUSTOMER][NEUTRAL] So they're, they're up to their max. You guys do not cover after that. You're not considered a secondary insurance, you're considered together.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK, that's what I thought. OK, that's what I wanted to make sure. OK, all right. Thank you very much for answering that.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You have a, you're welcome, Ma. You have a wonderful day. Thank you for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] You too.
[CUSTOMER][NEUTRAL] You too. Bye-bye.