AccountId: 011433970860
ContactId: c37f1833-8ffe-4548-aacf-c79a7dad54f0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 295350 ms
Total Talk Time (AGENT): 93302 ms
Total Talk Time (CUSTOMER): 176266 ms
Interruptions: 2
Overall Sentiment: AGENT=1.3, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/c37f1833-8ffe-4548-aacf-c79a7dad54f0_20250225T14:25_UTC.wav
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[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from Integrated Physical therapy and um we have a patient that has a Blue Cross Blue Shield and then she has you guys as I believe the supplemental insurance, so I just wanted to find out some information. We did get a verification back from our team that does that. However, they stated that you guys have covered something up after Medicare like what Medicare leaves off, but this patient does not have Medicare.
[AGENT][NEUTRAL] OK. Do you have a phone number I can get in case we get disconnected I can call you back?
[CUSTOMER][NEUTRAL] Absolutely that would be [PII] and I'm sorry, what did you say your name was again?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you [PII].
[AGENT][POSITIVE] You're welcome. And
[AGENT][NEUTRAL] What's the policy number?
[CUSTOMER][NEUTRAL] OK, that policy number would be, give me one second here.
[CUSTOMER][NEUTRAL] I have a group number on this card and then it also says uh inpatient in hospital benefit which this wouldn't be it, but it would be outpatient benefit cert number would that be the number you're looking for?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, that would be a 01637433 M as in [PII].
[AGENT][NEUTRAL] And what's the patient's name?
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Last name is [PII].
[AGENT][NEUTRAL] And her date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII] and you were just wanting to know if we coordinated with Medicare?
[CUSTOMER][NEUTRAL] No, if you guys actually coordinate with Blue Cross Blue Shield because this patient, OK, so let me ask you, um, for the information that I have regarding this particular it says there's no network status, are we like in or out of network with this policy or is there.
[AGENT][NEUTRAL] We do. Yes, ma'am.
[AGENT][NEUTRAL] OK, I can.
[AGENT][NEUTRAL] I can help you with that. This policy doesn't have a network. This policy only coordinates with their major medical insurance. We only pick up deductibles, co-pays, or co-insurances only up to a certain amount depending if you said it was for outpatient.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, we're an outpatient for so we're not um within the um within the hospital we're a stand alone.
[CUSTOMER][NEUTRAL] Boutique.
[AGENT][NEUTRAL] OK, the effective date is [PII] and any benefits given on the phones, not a guarantee of payment for outpatient, we'll pay up to 2500 per calendar year.
[CUSTOMER][NEUTRAL] And this is
[CUSTOMER][NEUTRAL] And none of that has been met as of yet?
[AGENT][NEUTRAL] Hold on just a moment, I'll check and see.
[CUSTOMER][POSITIVE] I appreciate that.
[AGENT][NEUTRAL] No, ma'am. They have not used anything for this year.
[CUSTOMER][NEUTRAL] OK, and you said that uh the effective day was uh [PII]?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Perfect. And then uh it does say that this plan will cover or pick up whatever's left behind. This is Medicare, but you're saying with her Blue Cross Blue Shield it also um covers the copay her $65 copay with uh Blue Cross Blue Shield?
[AGENT][NEUTRAL] Right, if it's outpatient, right.
[CUSTOMER][NEUTRAL] OK, and when you say the threshold is the 2500, is that renewed every year?
[AGENT][NEUTRAL] Every year is per calendar year.
[CUSTOMER][NEUTRAL] OK, perfect, and give me one second then after she's met that 2500, then she would be back responsible for her copay, correct?
[AGENT][NEUTRAL] Right, and if our major medical doesn't pay, we do not pay.
[CUSTOMER][NEUTRAL] OK, so it's only if they pay perfect and give me one.
[AGENT][NEUTRAL] Right. Only deductible, co-pay or co-insurance is all we pick up.
[CUSTOMER][NEUTRAL] OK perfect and then the group number for this is 20406 correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and the mailing address I have here is [PII]?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] OK, I really appreciate that and [PII], is there a reference number?
[AGENT][NEUTRAL] We do not have reference numbers. You can use my name in today's date.
[CUSTOMER][POSITIVE] Perfect I do appreciate that thank you so much for your time I appreciate it.
[AGENT][POSITIVE] Thank you, [PII], for calling APO. You have a good day.
[CUSTOMER][NEUTRAL] Oh, also I'm sorry, I do actually have one more question. Do you guys make payments to the patient or to the facility?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Uh, we accept the assignment. If you all file it with the assignment, we'll pay you all.
[CUSTOMER][POSITIVE] OK perfect thank you so much.
[AGENT][POSITIVE] Thank you, [PII].
[CUSTOMER][POSITIVE] Alright thank you bye.
[AGENT][NEUTRAL] Bye bye.