AccountId: 011433970860
ContactId: c1ab76b6-281a-4d9b-962b-2635f65d6f11
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 341410 ms
Total Talk Time (AGENT): 161334 ms
Total Talk Time (CUSTOMER): 87611 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/c1ab76b6-281a-4d9b-962b-2635f65d6f11_20250408T18:34_UTC.wav
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[AGENT][NEUTRAL] Afternoon, thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Hi, what was your name again?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Can you spell that for me please?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the first initial to your last name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Thank you. I'm calling from a provider's office to verify benefits for a member.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Are you needing to verify benefits only or do you also need [PII]?
[CUSTOMER][POSITIVE] Just benefits.
[AGENT][NEUTRAL] OK, I can help you with that. And who am I speaking with?
[CUSTOMER][NEUTRAL] [PII] last initial [PII].
[AGENT][NEUTRAL] Thank you. And [PII], what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number?
[CUSTOMER][NEUTRAL] It'll be 02608013.
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] And any information that is provided [PII] would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] Name is [PII] and their date of birth, give me one second.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, and on the supplemental policy, what type, excuse me, so what type of benefit information are you needing inpatient, outpatient or all?
[CUSTOMER][NEUTRAL] Yes, it'll be for outpatient physical therapy.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm sorry, it will be for outpatient physical therapy in office setting for in network.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so there is no network with AP.
[AGENT][NEUTRAL] So this policy is a supplemental policy to the primary health insurance, and on this supplemental policy, the outpatient benefit max per calendar year for covered outpatient services is for excuse me, $5000.
[AGENT][NEUTRAL] With no outpatient deductible?
[CUSTOMER][NEUTRAL] You said 500?
[AGENT][NEUTRAL] 5000.
[CUSTOMER][NEUTRAL] 5000
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Does that include a copays?
[AGENT][NEUTRAL] This plan is designed to help with co-pays, deductibles and co-insurance amounts of covered services. Now, office visits are not covered.
[CUSTOMER][NEUTRAL] Really
[AGENT][NEUTRAL] But we would be reviewing, we can review the treatment under that outpatient benefit.
[CUSTOMER][NEUTRAL] Oh OK so office settings isn't covered.
[AGENT][NEUTRAL] The treatment portion would be, but if there's an office visit fee.
[AGENT][NEGATIVE] That's billed, that's not covered.
[CUSTOMER][NEUTRAL] So yeah, so this is uh for physical therapy treatment and done in in office setting and they have a copay with their primary. I just wanted to see if this would cover the copay.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Again, I cannot guarantee payment. We will have to receive the claim along with the primary insurance company's explanation of benefits, [PII], for review.
[AGENT][NEUTRAL] But the treatment is something that can be reviewed under this outpatient benefit maximum that I provided for you.
[CUSTOMER][NEUTRAL] OK, give me 1 2nd.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] OK, OK, thank you so much.
[AGENT][NEUTRAL] And so just make sure that
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes ma'am explanation of benefits along with the claim because we do have to have that and then once we have processed our claim here at APL we do have a
[AGENT][NEUTRAL] Portal, [PII] that you should be able to check claim status for us by going to
[CUSTOMER][NEGATIVE] I'm sorry, you're cutting off.
[AGENT][NEUTRAL] Our portal website, once we've processed a claim that you should be able to go to and check claim status is located at [PII].
[CUSTOMER][NEUTRAL] Is there like a billing address we could submit the claims to?
[AGENT][NEUTRAL] Yes, ma'am. And it should also be on the ID card. Do you have a copy of the ID card?
[CUSTOMER][POSITIVE] I do. OK, yes. Thank you so much. I see.
[AGENT][NEUTRAL] Do you see that it's a PO box in [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, ma'am. That is where the claims will be submitted.
[CUSTOMER][POSITIVE] OK perfect thank you so much for your help.
[AGENT][POSITIVE] Well, you're welcome. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] No, that was all. Can I get a reference number please?
[AGENT][NEUTRAL] Yes, ma'am, you would use my name along with today's date.
[CUSTOMER][POSITIVE] OK, thank you so much for your help.
[AGENT][POSITIVE] Well, you're welcome and thank you again for calling APL. I hope you have a nice rest of your day.
[CUSTOMER][NEUTRAL] You as well bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.