AccountId: 011433970860
ContactId: 9187c62b-ed7c-442e-abc3-1e490fbeb02c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 347640 ms
Total Talk Time (AGENT): 159168 ms
Total Talk Time (CUSTOMER): 135640 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/9187c62b-ed7c-442e-abc3-1e490fbeb02c_20250604T13:30_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, good morning. You said your name is [PII]?
[AGENT][NEUTRAL] Um, it's [PII].
[CUSTOMER][NEUTRAL] OK. Thank you, [PII]. My name is [PII]
[AGENT][POSITIVE] Yes, ma'am. And how can I help you?
[CUSTOMER][NEUTRAL] I am calling to verify benefits of a member that mentioned having American Public Life as a gap insurance, and I've never heard of it before and I have no idea how it works.
[CUSTOMER][NEUTRAL] So I'm calling to get some information.
[AGENT][NEUTRAL] Um, sure, [PII], I can assist you with benefits. And first, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. Thank you. Now, could I get the policy number, please?
[CUSTOMER][NEUTRAL] 01480064 M for Mary L for Lima 8.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Thank you and just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII]. The policy is still active, and is this for inpatient or outpatient benefits or an office visit?
[CUSTOMER][NEUTRAL] It's physical therapy outpatient or as a facility. Mhm.
[AGENT][NEUTRAL] OK. That'll be covered under the outpatient benefits and under this policy for outpatient, we cover up to 3000 per calendar year and that's for the co-pay, the co-insurance, and the deductible after the primary insurance processes the claim.
[AGENT][NEUTRAL] So, um, what you'll do is, um, submit the claim to the primary carrier first. And once you receive the explanation of benefits from the primary insurance, you'll submit the claim to us along with the EOB from the primary carrier. And like I said, we cover up to 3000 per calendar year for outpatient services.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Got it. Am I sending that obviously via fax?
[AGENT][NEUTRAL] Um, yes, ma'am. You can fax it in. We have a pair ID or mail it in. Which way do you prefer?
[CUSTOMER][POSITIVE] 00, the payer ID will be great. I just have to put it in my system.
[AGENT][NEUTRAL] Hey, our payer ID is 60801.
[CUSTOMER][NEUTRAL] All right, perfect. May I have, in, in any case, cause I'd like to have my system clean the uh billing uh address and a fax number so that I can input all the information for your insurance in my system.
[AGENT][NEUTRAL] Um, yes, ma'am. Our fax number is
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII] and please attention it to the claims department.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the mailing address is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's in [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][POSITIVE] [PII]. All right, perfect.
[CUSTOMER][NEUTRAL] All right. Um, I think that's all I, do you have any, uh, have, cause I see, I saw from the primary insurance that the member has used one visit so far, so I'm assuming his accumulation is close to 0.
[AGENT][NEUTRAL] Um, let's see. For outpatient, like I said, we cover up to 3000 and so far he's used.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, so far he's used $1,762.78.
[AGENT][NEUTRAL] Oh, no, I'm sorry. That's under the inpatient benefit. I'm sorry. So for outpatient, he hasn't used anything. Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got it. No worries.
[AGENT][NEUTRAL] The full 3000 is available.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] So based on what you said at the beginning of the conversation that basically uh I don't have to charge because the patient has a based on the uh primary, he has a co-pay. We don't charge the co-pay for him because you're gonna cover that. Is that correct?
[AGENT][POSITIVE] Yes, ma'am, that's correct.
[CUSTOMER][NEUTRAL] All right, perfect. I just need to set it up correctly in my system. All right, perfect. Um, OK, I think I have everything that I need. Is there a limit on the number of visits just like for the primary or, or it's only the, the amount used?
[AGENT][NEUTRAL] Um, under this policy, it's only the amount, the 3000.
[CUSTOMER][NEUTRAL] OK, alright, perfect. May I have a reference number for the call?
[AGENT][NEUTRAL] Um, yes, for the reference number, you can use my name and today's date, and my name is spelled [PII], and today's date. Um, is there anything else I can assist you with?
[CUSTOMER][POSITIVE] No, that will be all. I appreciate all your help, uh [PII] and have a great day.
[AGENT][NEUTRAL] You do the same, [PII]. Thank you for calling APL. Mm bye.
[CUSTOMER][POSITIVE] Take care. Bye-bye.
[AGENT][POSITIVE] Mm thanks.