AccountId: 011433970860
ContactId: 8edc55b2-cfb8-47ac-b8af-05f237e45429
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 393279 ms
Total Talk Time (AGENT): 171937 ms
Total Talk Time (CUSTOMER): 208232 ms
Interruptions: 6
Overall Sentiment: AGENT=0.6, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/8edc55b2-cfb8-47ac-b8af-05f237e45429_20250129T21:52_UTC.wav
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[AGENT][NEUTRAL] Can I help you?
[CUSTOMER][POSITIVE] Hi, good afternoon.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII].
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I'm calling as a provider. It's the first time we called to APL, so we need to know how it works because we have a patient that sent us, uh, the insurance card.
[AGENT][NEUTRAL] OK, spell your name for me?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and are you calling to verify benefit information?
[CUSTOMER][POSITIVE] Yes please.
[AGENT][NEUTRAL] OK. And did you say that the service is in a doctor's office or outpatient setting, facility setting?
[CUSTOMER][NEUTRAL] Facility, yeah.
[AGENT][NEUTRAL] OK, and you're calling on behalf of the facility?
[CUSTOMER][NEUTRAL] Yeah, we, we don't know how it works because we are, we are out of network. We don't know how it works because it's the first time we have a patient of the insurance card.
[AGENT][NEUTRAL] OK, so you're calling on behalf of the hospital?
[CUSTOMER][NEUTRAL] Yes, I'm calling you from the provider's office.
[AGENT][NEUTRAL] OK. Do you have the policy number?
[AGENT][NEUTRAL] OK. Do you have the policy number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um, let me see, so is, is where say the payer ID?
[AGENT][NEUTRAL] And uh, the policy er number starts with a 0 maybe?
[CUSTOMER][NEUTRAL] Because
[CUSTOMER][NEUTRAL] Uh,
[AGENT][NEUTRAL] Near the bottom of the page.
[CUSTOMER][POSITIVE] Mm, oh yes, outpatient benefits.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. 02566425 M for [PII].
[AGENT][NEUTRAL] OK, and what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] OK. [PII].
[AGENT][NEUTRAL] Thank you. What's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. I have that name, but I don't know because they are requesting for [PII]. So I don't know if it's the same number, but let's check [PII], date of birth [PII].
[AGENT][NEUTRAL] And [PII] is the patient?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But I don't know if it's under that or under her. That's why it's the first time we call, we don't know.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] You know, she's a dependent on the policy. So, um, I show the policy effective date is [PII].
[CUSTOMER][NEUTRAL] What are the steps?
[CUSTOMER][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] Um, the policy is active at this time.
[AGENT][NEUTRAL] And you're needing just the outpatient facility benefit?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And a speech therapy benefits?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Speech therapy benefits. I have CPT codes if you want to.
[AGENT][NEUTRAL] Um, let me see. That's OK. I can see if speech therapy is covered. Uh, one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Is that a live piano that I hear in the background, or is that like a just a CD or music or something, a radio?
[CUSTOMER][NEUTRAL] Yeah, I'm in the office and maybe it's the, the news, let me just put it a little bit down, yeah.
[AGENT][POSITIVE] No, I like it. I was just wondering if it was someone playing a piano or was it just like on a radio.
[CUSTOMER][NEUTRAL] Is the
[CUSTOMER][NEUTRAL] Mm, no, no, it's it's, it's the music.
[AGENT][POSITIVE] Oh, OK. I like it.
[CUSTOMER][NEUTRAL] The jazz music for the way you run.
[AGENT][POSITIVE] I love it, yeah, that's what I thought.
[CUSTOMER][NEUTRAL] Sorry.
[AGENT][NEUTRAL] What station is that?
[CUSTOMER][POSITIVE] Sorry about that.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] It just, jazz music.
[AGENT][NEUTRAL] I know it, but what station?
[AGENT][NEUTRAL] I
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Hello
[AGENT][NEUTRAL] Is it like a radio station or do you just like have a CD or something with the jazz music?
[CUSTOMER][NEUTRAL] No, in, uh, YouTube, you play like a jazz relaxing for waiting rooms.
[CUSTOMER][POSITIVE] And it's gonna show, it's gonna show you a screen, a relaxed screen.
[AGENT][NEUTRAL] OK. I got you. OK, OK.
[AGENT][NEUTRAL] I don't really rarely, I rarely find it that soft and gentle, you know, um.
[CUSTOMER][POSITIVE] Yeah, it's good. When it's [PII] time, you have a screen about [PII], you know, that, like a snow monte so you can just set up like for fall, for [PII], spring.
[AGENT][NEUTRAL] Jazz music.
[AGENT][NEUTRAL] Mm, mhm, mhm.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] Exactly.
[AGENT][NEUTRAL] Right, right. Let's see.
[AGENT][NEUTRAL] Yeah, only physical therapy is covered under this policy, not speech therapy.
[CUSTOMER][NEUTRAL] Oh, OK, so it's not covered.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Speech therapy is not covered.
[CUSTOMER][NEUTRAL] OK, OK, it's good to know. OK, uh, a question if we, if we don't have a contract with, with you guys, so how works? We just bill to you or how works just in the future if someone send you this.
[AGENT][NEUTRAL] So this is a Metlink policy. Uh, it's a supplemental policy to the major medical plan. So we would pay a secondary, uh, you know, if it, if it's covered charges.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And so you would just you know of course submit it to the primary insurance first and then send APL the itemized bill and the major medical ELB for review.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] Oh, so you are the secondary payer.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Oh, OK, I understand. So if we are not in network, you can pay the bills?
[AGENT][NEUTRAL] So there is no network affiliated with this plan because we're secondary to the major medical coverage. And so, uh, the the amounts applied towards the major medical deductible, co-insurance, and or co-pay amounts of covered charges. In this instance, speech, speech therapy isn't covered, but a covered charge will reimburse those amounts up to the outpatient policy benefit maximum.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Oh, OK. OK, it's good to know. Thank you so much.
[AGENT][NEGATIVE] Yeah, but in this instance, it wouldn't be covered because speech speech therapy is not covered under this plan.
[CUSTOMER][NEUTRAL] So you can pay this uh for her other deductible. You cannot pay this because this is speech therapy, correct? OK, OK.
[AGENT][NEUTRAL] Cannot.
[AGENT][NEGATIVE] Which is not covered under this policy.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][NEUTRAL] All right, [PII], any other questions I can help with today?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, thank you.
[AGENT][POSITIVE] All [PII]. Thank you for calling APL. Have a good day.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] You too thank you.