AccountId: 011433970860
ContactId: b5e20401-72a2-479b-af46-6154f410d8e6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 475329 ms
Total Talk Time (AGENT): 190256 ms
Total Talk Time (CUSTOMER): 115663 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/b5e20401-72a2-479b-af46-6154f410d8e6_20250115T15:51_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII], and I was calling with a question um about my benefits and making a claim.
[AGENT][NEUTRAL] OK, I can help you with your claim, um.
[AGENT][NEUTRAL] Miss [PII], what is your callback number just in case the call gets disconnected?
[CUSTOMER][NEUTRAL] Sure, it's area code [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, ma'am. And then what is your policy number?
[CUSTOMER][NEUTRAL] 2462849
[AGENT][NEUTRAL] OK, let me pull your policy in for us real quick.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, Miss [PII], can you verify your date of birth for me, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then also, what is your address, phone number and email address that we have on the policy for you?
[CUSTOMER][NEUTRAL] Sure, it is [PII]. The phone number is [PII] and the email, I believe it's [PII].
[AGENT][POSITIVE] Yes ma'am, that's correct. Thank you so much and, and you might you have some questions about filing a claim. How can I help you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes. So, I wanted to, uh, cause I'm not sure I can file, but I've, um, I have had some shoulder issues, so I needed, I've been sent to an orthopedic um doctor as well as physical therapy, and I wanted to find out if the co-pays for those visits are covered with my gap insurance that I could file for.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, um, give me a quick second to pull in your policy and look.
[AGENT][NEUTRAL] And see if you have physical therapy benefits on your policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's gonna be just a second. It's gonna take a minute for the computer to.
[CUSTOMER][NEUTRAL] Oh sure.
[AGENT][NEUTRAL] Pull it in and then I'll have to go through and read it. It'll be just a moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Of course it's taking its sweet time always when you got somebody on the phone it decides it wants to be slow.
[CUSTOMER][POSITIVE] Oh, no worries. I know.
[AGENT][NEUTRAL] OK, that's finally pulled up, so let me scroll through it and see what I can find as far as your physical therapy benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK. It does have physical therapy benefits for you.
[AGENT][NEUTRAL] Um, and it says, let me read to you what it says so that you'll know, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Cause it, it goes by facility also where you're having it done. The treatment of physical dysfunction or injury at a physical therapy facility by the use of a therapeutic exercise and the application of modalities intended to restore or facilitate normal function or development, physical therapy does not include uh chiological speech or occupational therapy or equipment recommended use or purchased.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For use outside of the physical therapy facility. So, and the, they define physical therapy facility as an office center or clinic in which a licensed physical therapist provides physical therapy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK. So then, um,
[AGENT][NEUTRAL] So it sounds, it's.
[AGENT][NEUTRAL] And that's just to verify your coverage. It's not a guarantee of payment.
[CUSTOMER][NEUTRAL] Yeah, it's.
[CUSTOMER][NEUTRAL] Sure. So then I can just go online and um follow the process to file a claim um for what I've paid out of pocket for my visits so far?
[AGENT][NEUTRAL] Yes, ma'am. And what you'll need um to file your claim, you'll need to have the explanation of benefits from your primary insurance where they paid their part.
[AGENT][NEUTRAL] You'll also need the itemized statement.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, from the facility to that has the diagnosis codes and procedure codes, and then your claim form.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Office code.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Great. And did the, do the, what is the time frame to be filed within like date of service?
[AGENT][POSITIVE] It's awesome that we do not have a timely filing limit. So as long as you're covered on the day of service, you can file at any time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. I mean, I don't wanna wait, but sometimes it takes a little bit to get the forms from the, you know, main in from the primary insurance and all of that. So that's I just was wondering.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Yeah, OK, this is great thank you so much for um for your help on that.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're very welcome um we appreciate you being an APL customer and I don't mind helping you at all. I enjoy it so if you have any other questions or you get into the claim and you need help, just call us and we'll help you all we can.
[CUSTOMER][POSITIVE] OK, thank you, [PII]. Have a good day.
[AGENT][POSITIVE] You too and thanks for calling APL you have a great day also.
[CUSTOMER][NEUTRAL] Bye-bye.
[AGENT][NEUTRAL] Bye bye.