AccountId: 011433970860
ContactId: bfc0e4fb-52b3-4bf1-8407-03d35b9795a4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 423660 ms
Total Talk Time (AGENT): 137626 ms
Total Talk Time (CUSTOMER): 152726 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/25/bfc0e4fb-52b3-4bf1-8407-03d35b9795a4_20250325T16:12_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is speaking. May I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII], and I'm with sports and orthopedics, Dr. [PII]'s office. I was calling in on a mutual patient. Um, we've been seeing this patient with just her Blue Cross Blue Shield, but now she's telling me that she's got a secondary, so I'm needing to get, I guess, information regarding this plan.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I can verify benefits and eligibility for you. And Ms. [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] Um, it is 0246332 for [PII].
[AGENT][POSITIVE] Thank you so much. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] OK, thank you, ma'am. And that patient's name, date of birth?
[CUSTOMER][NEUTRAL] [PII]'s date of birth is [PII].
[AGENT][NEUTRAL] And it sounds like you're missing a number with the policy number. Do you have a copy of the card?
[CUSTOMER][NEUTRAL] I do not. This was just the information that was given to us over the phone [PII].
[AGENT][NEUTRAL] Yeah, it sounds like it's missing number. You said her name is [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, give me one moment.
[AGENT][NEUTRAL] I apologize, I'm having issues today.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Oh, you're OK.
[CUSTOMER][NEUTRAL] I mean, uh, if I need to get the card, I can call the patient back and ask for the card. Like I said, we did, we have just been seeing her with her Blue Cross, and then she said she had a secondary so I'm not real sure if it's like a true secondary, but I can call her and get a copy of the card.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And does she spelled [PII] or [PII]?
[CUSTOMER][NEUTRAL] So it's with a [PII] and then [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and what state is she from?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and verify her date of birth for me, please?
[CUSTOMER][NEUTRAL] Patient's date of birth is [PII].
[AGENT][NEUTRAL] OK. Yes, ma'am, it's missing an extra 3.
[AGENT][NEUTRAL] So it's [PII].
[CUSTOMER][NEUTRAL] 3 OK so there's [PII] OK.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] And do you have a callback number in case the call disconnects?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. You did give that to me. OK. I'm showing her effective date is [PII] and she is active on the policy. And what benefits you're needing for the patient?
[CUSTOMER][NEUTRAL] Um, so for a specialist office visit and for physical therapy.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, under the policy, it does not cover office visits. Um,
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And let me double check as far as physical therapy. Give me one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, well, under the policy, uh, physical therapy is covered as outpatient, not a guarantee of payment, just a verification of coverage. With our company is secondary, we pick up what primary insurance applies towards deductible, co-pay or co-insurance.
[AGENT][NEUTRAL] And she has an outpatient benefit that pays up to $1000 per calendar year.
[CUSTOMER][NEUTRAL] $1000 per calendar year.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And so it should pick up whatever Blue Cross doesn't cover, correct?
[AGENT][NEUTRAL] Only what they apply for deductible, co-pay, or co-insurance.
[CUSTOMER][NEUTRAL] What Blue Cross.
[CUSTOMER][NEUTRAL] Sorry, I'm just trying to write all this down here.
[AGENT][NEUTRAL] No, you're fine.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Co-pay, deductible and coinsurance, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And so, um, and that's with physical therapy but there's not any coverage for office visits, so then, um, when, so once she hits that 1000 then um she would be responsible at that point.
[AGENT][POSITIVE] Uh, correct.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Once she's met her benefit max, then she has met her max for the year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'm not sure how many times that they actually want her to come into PT, but I can double check on that, um, OK, and where do we need to send the claims to?
[AGENT][NEUTRAL] Uh, mail address is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You said 71324?
[AGENT][NEUTRAL] No, ma'am. 73124.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 8950.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 8950.
[CUSTOMER][NEUTRAL] And what is the name of this company again please?
[AGENT][NEUTRAL] APL.
[CUSTOMER][NEUTRAL] APL.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alrighty, can I please get your name and a reference number for the call, please?
[AGENT][NEUTRAL] Uh, we don't give reference numbers. You may use my name today's date and my name is [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] OK great thank you so much for your help I appreciate you.
[AGENT][POSITIVE] Alright, you're welcome, Ms. [PII], and thank you for calling APL. Have a great day.
[CUSTOMER][POSITIVE] Thanks you too bye bye.
[AGENT][NEUTRAL] Bye.