AccountId: 011433970860
ContactId: a9ba2f45-f532-4cdf-b8f6-81db31159c21
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 637619 ms
Total Talk Time (AGENT): 337089 ms
Total Talk Time (CUSTOMER): 363899 ms
Interruptions: 8
Overall Sentiment: AGENT=1.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/a9ba2f45-f532-4cdf-b8f6-81db31159c21_20250320T13:14_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, how you doing? I wanted to find out some information about uh what particular coverage I had um.
[CUSTOMER][NEUTRAL] I need to do some physical therapy, and I wanted to see if this was covered by APL or not.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Well, it would be my pleasure to assist you with those benefits. Do you happen to have your policy number available?
[CUSTOMER][NEUTRAL] Um, I have a group number, an in hospitals benefit number, an outpatient benefit number.
[AGENT][NEUTRAL] What is that outpatient benefit number?
[CUSTOMER][NEUTRAL] I don't know what other.
[CUSTOMER][NEUTRAL] Outpatient benefit number is 0189.
[CUSTOMER][NEUTRAL] 283 9.
[CUSTOMER][NEUTRAL] M as in Mary, L as in Larry, and then the number 8.
[AGENT][NEUTRAL] All right, thank you. And do you mind verifying your name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] I'm a you like baby too.
[CUSTOMER][NEUTRAL] How are you? Uh.
[AGENT][NEUTRAL] Yeah I am this month, right?
[CUSTOMER][NEUTRAL] I just, I just missed the [PII] by like I believe 30, half an hour.
[AGENT][NEUTRAL] I see that.
[AGENT][NEUTRAL] Uh, about half an hour, are you?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Well, you, you'll get to have two days of celebration now. [PII] and your birthday.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, I would, I'd mess with my kids and I tell them, look at look how they uh bring in my birthday every year, you know.
[AGENT][NEUTRAL] What
[AGENT][NEUTRAL] That's right, but fireworks and everything, right?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Well, I'm on the [PII], so I missed it by a couple of days. Yeah.
[CUSTOMER][NEUTRAL] Oh, are you? Not, not too far behind. Yeah.
[AGENT][NEUTRAL] Not too far. And Mr. [PII], can you verify, uh, what is a good callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and if we could just get that address and email verified.
[CUSTOMER][NEUTRAL] [PII], uh, [PII] I believe.
[AGENT][POSITIVE] That's what we have on file, thank you.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And you said you were needing a physical therapy, is that right?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah, yeah, I need to do some physical therapy on my, um, my, my lower back area, try to build up core strength, I think.
[AGENT][POSITIVE] Oh my gosh, me too.
[CUSTOMER][NEUTRAL] Yeah, so.
[AGENT][NEUTRAL] I'm fixing to start physical therapy for the same reason.
[CUSTOMER][NEUTRAL] Yeah, my whole lower back L4.
[AGENT][NEUTRAL] It must be something about us.
[AGENT][POSITIVE] Oh my gosh, yeah.
[CUSTOMER][POSITIVE] L4, L5, S1, all, and I have spinal stenosis and, you know, all the good stuff.
[AGENT][POSITIVE] Oh my goodness. Well, I certainly would.
[CUSTOMER][NEUTRAL] Yeah, well, I hope, I hope you get better.
[AGENT][NEUTRAL] Yeah, I fell off a horse a couple of years ago and now they found I have a pinched nerve. So, yeah, well, I got thrown off and.
[CUSTOMER][NEUTRAL] Oh, did you?
[AGENT][NEUTRAL] Yeah. I've been dealing with it ever since. Oh well.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] What are you
[CUSTOMER][NEUTRAL] I have a friend of mine that that he was on a horse. The horse got spooked. He fell off and it dragged him, and he
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] He had to have part of his, he had to have his part of his head, you know, his scalp removed from the, uh, he's never been the same ever since.
[AGENT][NEUTRAL] Oh my God
[AGENT][NEUTRAL] Oh my goodness. Yeah, my back hadn't been the same.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] But it was fun while it lasted.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah, right.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] It was like one of the best rides I've been on and then just didn't end well. He, he.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, how you
[AGENT][NEGATIVE] took off around a tree and I didn't go with him.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] So, uh, same thing, he got spooked and started. I did need a seat belt, but he, he got spooked and, and took off and I just didn't go with him. He went left and I went right.
[CUSTOMER][NEUTRAL] I need a seat belt.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] I hope it all works out for you.
[AGENT][POSITIVE] But anyway, I hope it works out for you too. We're gonna get better it must be something with the July kids, [PII] July kids. I don't know.
[CUSTOMER][POSITIVE] Perfect thank you.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I don't know.
[AGENT][NEUTRAL] But
[AGENT][POSITIVE] Uh, I can help you with that benefit now. Your physical therapy is covered under your outpatient benefit.
[CUSTOMER][NEUTRAL] OK. So it is covered.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] It is covered. So you, um, your calendar year benefit is up to $7500 that we can pay towards your deductible, co-pay or co-insurance of your major medical.
[AGENT][NEUTRAL] So make sure that you give him your primary insurance card and your APL card when you go.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Now I will have to tell you that all benefits given over the phone is a verification of coverage, not a guarantee of payment, simply means we can't process the claim and guarantee payment over the phone.
[CUSTOMER][NEUTRAL] OK. So, so it is 100% covered that outpatient physical therapy, like I have my order right here. It says physical therapy requisition, you know, whatever, whatever. So I just give them the APL information as the second insurance.
[AGENT][POSITIVE] That's right.
[CUSTOMER][POSITIVE] OK, alright and alright so that so that's good news I can get that started because that's high deductible, um.
[AGENT][NEUTRAL] Uh, it's tough, isn't it?
[CUSTOMER][NEUTRAL] Yeah, I mean, when you hit a certain age, every doctor you go to lines with an IST, you know, the, the, the, the gastrologist, the urologist, the cardiologist, you don't go to the regular doctor anymore and it's
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Don't you miss those days where we just went to one doctor, and you may be too young.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Well, I'm, I'll be 55 this year.
[AGENT][NEUTRAL] But
[AGENT][POSITIVE] Yeah, uh, I'm about 10 years ahead of you.
[CUSTOMER][NEUTRAL] Yeah, you don't sound like it. Um.
[AGENT][POSITIVE] Oh, thanks.
[CUSTOMER][NEUTRAL] I just, yeah, I have a, I had, I've already, I have heart disease in the family. I had a stent put in when I was 49. Um, so I've been seeing a cardiologist since then.
[CUSTOMER][NEUTRAL] You know, and just as you get older, you know, things, you know, it's like a car, things start to break down, yeah.
[AGENT][NEUTRAL] It changes.
[AGENT][MIXED] Yeah, and you do everything. I, I try to do everything I can to keep it all together, but I want it's just falling apart faster than I can keep it together.
[CUSTOMER][NEUTRAL] Yeah, I used to, I, I was, I was very heavy. I was 331 pounds and I've lost over 100 pounds, so.
[AGENT][POSITIVE] Oh, that's amazing.
[CUSTOMER][POSITIVE] Yeah, so I've tried to do everything possible to help myself, but it seems like I was in better shape when I was heavier. That's the funny part.
[AGENT][POSITIVE] You know what, I kind of agree cause I've lost over 100 pounds too and it's almost like all that fat cushions your joints and they didn't hurt as much and
[CUSTOMER][NEUTRAL] They just
[CUSTOMER][NEGATIVE] Yeah, yeah, yeah. No, I was told lose all the weight, your back will be better. No, it's, it seems like it's getting worse.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] I think it, um, it takes all that cushion away or something in the joints.
[CUSTOMER][POSITIVE] Well, to be honest with you, I'm very active. I work out every day. I play, you know, I play softball, you know, slow pitch with my son, and I've started playing pickleball about a year ago, and ever since I started playing that, I think it's when I really started to get my back started to get beat up even worse.
[AGENT][NEUTRAL] Mhm.
[AGENT][MIXED] See, that's funny because I have wanted to do that, but I'm like, I'll probably fall and break my hip or something like that.
[CUSTOMER][NEGATIVE] It's very hard on the body.
[CUSTOMER][MIXED] It it's, it's very addicting game to play, but it's very hard on the body.
[AGENT][NEUTRAL] I need a cushion.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I see, I need one of those, what, you know, those inflatable sumo wrestler outfits that people wear.
[CUSTOMER][NEUTRAL] Hey, yeah man.
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah, yeah, well, while I have you on the phone, I got one other question is, is blood work is blood work covered under APL as well? Like I'm, I had some blood work done and they, they're sending me bills for additional test or whatever they did that was not covered by my insurance, but is that covered under APL as well or no?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Was that through an independent lab such as Quest or Labor, or yeah, it is covered. You do have what's called the independent lab facility rider, which does cover independent lab charges. Now, I'm
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so I can just go ahead, I'm sorry, I didn't mean.
[AGENT][NEUTRAL] Was it quest?
[AGENT][NEUTRAL] No, you're fine.
[CUSTOMER][NEUTRAL] It's Quest, yeah.
[AGENT][NEUTRAL] OK, so I will tell you that a lot of times we have trouble getting claims from Quest in [PII], don't know why, but if you can call and give them our information, kind of keep a check on it because sometimes they'll say they've sent claims to us 3 or 4 times and we never get them.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, it is.
[CUSTOMER][POSITIVE] Well, I have, I have sent, I gave him your information. I gave him everything. The funny thing is my wife went there the other day to do blood work at Quest, right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] And they refused her. They told her she has a past due balance and they wouldn't even do her blood work.
[AGENT][POSITIVE] Wow.
[CUSTOMER][NEUTRAL] And my wife's like, I gave you all the information. I gave you the APL. I gave you this. I gave you that. I don't understand what the issue is.
[AGENT][NEUTRAL] That very well could be. Do you know what that data service was? I was just checking to see if we've received a claim.
[CUSTOMER][NEUTRAL] I don't, I don't know. I have to go back and look, but um.
[CUSTOMER][NEUTRAL] I, I will definitely look back into.
[AGENT][NEUTRAL] I think it might have been at the beginning of the year maybe.
[AGENT][NEUTRAL] Around February. Yeah.
[CUSTOMER][NEUTRAL] Ah
[CUSTOMER][NEUTRAL] I don't, I, I don't know. I don't know, to be honest, I can't tell you that yes or no. um.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Got yo[PII]
[CUSTOMER][NEUTRAL] But I know that they turned her away yesterday or two days ago.
[AGENT][NEUTRAL] That is, I just, anyway, I'm sorry, I'm not gonna get started because.
[CUSTOMER][NEUTRAL] No, no, I hear you. I actually had to have some blood work.
[AGENT][NEGATIVE] You're gonna, you're gonna hear the cancer part of me coming out.
[CUSTOMER][NEUTRAL] Yeah, I, I actually had to have some blood work done too and I, I didn't go to class because I have a balance with them as well. And I keep giving me information and they keep telling me to keep coming back at me, so I just went to Laborp this time because to bypass the issue.
[AGENT][NEUTRAL] Yeah, they're easier to get claims from, yeah, absolutely, and I don't know why it's just we've noticed that. I mean if if that bill is from Quest and you call them and give them our policy information if they still bill you, you can call us back we'll do a 3 way call with them and tell them to fax it to us or you can submit the claim yourself for reimbursement.
[CUSTOMER][NEGATIVE] I said no I'm not gonna.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so the
[CUSTOMER][NEUTRAL] Yeah, um, OK, so all the information that I have though is correct like the outpatient benefit number and all that stuff.
[AGENT][NEUTRAL] That's right, and I see you have an active portal account on our website. If you ever want to view what's covered on your policy, all you have to do is click the policy number. Your document will download and within the document there's a page called the Schedule of benefits page, and it has everything listed, all the uh services listed that are covered.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well I, I did see it it covered PT, but I just wanted to call and make sure.
[AGENT][POSITIVE] Absolutely.
[CUSTOMER][POSITIVE] I, yeah, because I'd rather be safe than sorry, but OK, I appreciate it. Thank you so much. Thank you for your time and I, and I hope you feel better as well and uh.
[AGENT][POSITIVE] Well, it's been such a, been a pleasure. I hope you do too, and it's been such a pleasure to assist you. And if you need anything else, Mr. [PII], never hesitate to give us a call.
[CUSTOMER][NEUTRAL] Yeah, right.
[CUSTOMER][POSITIVE] Will do thank you so much and have a great day.
[AGENT][POSITIVE] You too, Mr. [PII]. Thank you for calling APL. Take care.
[CUSTOMER][NEUTRAL] Bye bye bye bye bye bye.
[AGENT][NEUTRAL] Bye.