AccountId: 011433970860
ContactId: ad0b1342-bff3-4f4a-9ddc-7de449ad2cfb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 449679 ms
Total Talk Time (AGENT): 148456 ms
Total Talk Time (CUSTOMER): 192254 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/14/ad0b1342-bff3-4f4a-9ddc-7de449ad2cfb_20250314T20:22_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Yeah, good afternoon in [PII].
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I need the information of patient, if you don't mind.
[AGENT][NEUTRAL] OK, may I ask who's calling?
[CUSTOMER][NEUTRAL] This is [PII].
[AGENT][NEUTRAL] And do you have a phone number I can get in case we get disconnected, I can call you back.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, yes.
[CUSTOMER][NEUTRAL] A second.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The benefit card number, that would be the policy number, right? Yeah. 024.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] 651
[CUSTOMER][NEUTRAL] 68
[CUSTOMER][NEUTRAL] MLS
[AGENT][NEUTRAL] Thank you. Hold on one moment, please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you're the insured or with the provider?
[CUSTOMER][NEUTRAL] No, I, I'm a provider.
[AGENT][NEUTRAL] Oh, you're with the provider.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And who's the patient?
[CUSTOMER][NEUTRAL] The patients [PII].
[AGENT][NEUTRAL] And her date of birth?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you were needing claim status or benefits.
[CUSTOMER][NEUTRAL] That benefits, and that's the first time I, uh, had this kind of.
[CUSTOMER][NEUTRAL] Uh, the patient that hold this gap. At first I was wondering, uh, how it works because I look at her primary insurance is Aetna, and the deductible is too high, so probably you're the one that should pay this bill for physical therapy. I was wondering, as soon I perform the services, how do I submit the claim to you?
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Actually, she has a different policy number. It is 01.
[AGENT][NEUTRAL] 65.
[AGENT][NEUTRAL] 9511.
[CUSTOMER][NEUTRAL] 01659511. OK.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] And this policy coordinates with the primary insurance, whatever the primary applies to their deductible co-pay or co-insurance only.
[AGENT][NEUTRAL] We'll pick up, depending on what type of service it is, is it outpatient inpatient or doctor's office?
[CUSTOMER][NEUTRAL] His doctor's office.
[CUSTOMER][NEUTRAL] And that is physical therapy.
[AGENT][NEUTRAL] So it was gonna be covered if its physical therapy, it's gonna be covered under outpatient.
[CUSTOMER][NEUTRAL] What is, yeah, that's what I thought.
[AGENT][NEUTRAL] And for outpatient we'll pay up to.
[AGENT][NEUTRAL] $7900 per calendar year.
[CUSTOMER][NEUTRAL] And that she has used it this year or no?
[AGENT][POSITIVE] Hold on, I'll check for you.
[AGENT][NEUTRAL] She hasn't used anything.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, I submit the claim to the prime insurance, Aetna.
[CUSTOMER][NEUTRAL] Probably they will deny, we're gonna say that's the patient's responsibility, and then I submit to you. That's the right way to do it.
[AGENT][NEUTRAL] Right, and if, if they do not pay, we do not pay.
[CUSTOMER][NEUTRAL] Well, the, the problem is,
[CUSTOMER][NEGATIVE] She, I'm looking here right now, the deduct, her deductible is too high.
[AGENT][NEUTRAL] Right, if they apply it to the deductible now, we'll pay up to that 7900, but if they don't pay at all.
[CUSTOMER][NEUTRAL] So that means
[AGENT][NEGATIVE] And don't apply anything, then we won't pay.
[CUSTOMER][NEUTRAL] Yeah, cause they were, they
[CUSTOMER][NEGATIVE] They will not, yeah, because they, they're not gonna pay at all because uh I'm looking here, she said she has $6000 as deductible.
[CUSTOMER][NEUTRAL] And that is $0. So if I submit $100 the insurance is gonna say that's the patient responsibility.
[CUSTOMER][NEGATIVE] I thought in this case that you, they're going to cover it, because they're going to pay nothing.
[AGENT][NEUTRAL] Right, if they don't pay anything, but on the explanation of benefits from her primary.
[AGENT][NEUTRAL] If it has something applied to her deductible, even though they don't pay, we're still going to pick up that deductible.
[CUSTOMER][NEUTRAL] And you're gonna pay, right? That's, that's the only question. OK, that's the only answer I want to talk to you.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] The only reason we would not pay if they do not pay, if they do not apply anything to their deductible co-pay or co-insurance.
[CUSTOMER][NEUTRAL] I got it. So I'm sure they will apply it.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, uh, how do I submit this claim to you?
[AGENT][NEUTRAL] You can mail it, fax it or upload it on our online service center.
[CUSTOMER][NEUTRAL] Uh, the, um, the fax number is [PII].
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, which, which one is faster?
[AGENT][NEUTRAL] The online service center.
[CUSTOMER][NEUTRAL] If for me to go to online center because I tried to do it without not different patient, uh, did not accept me to go through, do I need uh some special?
[CUSTOMER][NEUTRAL] Password or something?
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] No, you would have to set up an account and then it'll let you upload the claims.
[CUSTOMER][NEUTRAL] OK, I, I have to, uh, sorry, go ahead.
[AGENT][NEUTRAL] That's at, um.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] That's, that's what I have. So if I go there, each page that I have for your insurance, I have to open an account or only one account for everybody?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, just one, and then you should be able to upload the claims.
[CUSTOMER][POSITIVE] OK, thank you very much. I if I have a trouble to, to
[CUSTOMER][NEUTRAL] To, to
[CUSTOMER][NEUTRAL] Make this account you load it. Do I have a number I can call to help me out because I, I, I remember I had this thing this.
[AGENT][NEUTRAL] Upload it.
[AGENT][NEUTRAL] It would be the same number, same number you called. Anybody would be able to help you with that.
[CUSTOMER][NEUTRAL] The same number.
[CUSTOMER][POSITIVE] OK. So thank you very much for your help.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, that's it, thank you.
[AGENT][POSITIVE] Thank you, [PII], for calling APL. You have a good afternoon.
[CUSTOMER][NEUTRAL] Same for you. Bye.
[AGENT][NEUTRAL] Mhm. Bye-bye.