AccountId: 011433970860
ContactId: c8fe0c61-452c-4d97-9bc6-92ae523443ad
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 392640 ms
Total Talk Time (AGENT): 118494 ms
Total Talk Time (CUSTOMER): 181552 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/c8fe0c61-452c-4d97-9bc6-92ae523443ad_20250425T19:41_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi there, I am calling from Cardio flex therapy and I have a patient that just came in and they brought this insurance with them as well and I just wanted to check um some information, wanted to get their benefits eligibilities and everything.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, I can help you with benefits and eligibility. Could I get your name and a good callback number, please?
[CUSTOMER][NEUTRAL] Yeah my name is [PII] and the best callback number is [PII].
[AGENT][NEUTRAL] OK, thank you, [PII]. And do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] I have here there um let's see there.
[CUSTOMER][NEUTRAL] Their outpatient benefit cert number?
[AGENT][POSITIVE] Yes, that'd be right.
[CUSTOMER][NEUTRAL] OK, it's gonna be 02465909 M as in Mary, L as in London 8.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII], date of birth is going to be [PII].
[AGENT][NEUTRAL] OK, thank you. Looks like the policy is effective [PII], currently active.
[CUSTOMER][NEUTRAL] [PII] OK.
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] Get the policy pulled up.
[AGENT][NEUTRAL] And is this for outpatient services or what type of benefits?
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] Um, we are, we're a physical therapy office, so it's gonna be outpatient.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What did you say?
[CUSTOMER][NEUTRAL] phone number
[CUSTOMER][NEUTRAL] No, just that one.
[AGENT][NEUTRAL] OK, not a guarantee of payment basic outline of the policy. This policy pays a maximum of $3000 per calendar day.
[AGENT][NEUTRAL] So this is like a secondary policy after primary insurance processes the claim, any deductible, co-pay or co-insurance, this will pay up to $3000 per day.
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Per OK, wait, so that was gonna be max 3000 per day?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and let me see here.
[CUSTOMER][NEUTRAL] Um, are there any benefits paid?
[AGENT][NEUTRAL] Um, no, I don't show any pay because it's a per day benefit.
[CUSTOMER][NEUTRAL] OK, um, and let's see here what is the deductible?
[AGENT][NEUTRAL] There's no deductible.
[CUSTOMER][NEUTRAL] No deductible, OK.
[CUSTOMER][NEUTRAL] And is this in network with us, do you know?
[AGENT][NEGATIVE] We don't have a network. There's no applicable network.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, OK, let me see here.
[CUSTOMER][NEUTRAL] And the benefits like it's just per day it's not per year so.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So give me just a moment.
[CUSTOMER][NEUTRAL] It's not like in network or out of network, she said it's just kind of like there's no network.
[CUSTOMER][NEUTRAL] We're not in it.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Well, there's no like if there's no network, she said she said it's 3000 per day max that's it's all she's.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEGATIVE] They're not deductible.
[CUSTOMER][NEUTRAL] And ask what what's the max benefit.
[CUSTOMER][NEUTRAL] That's what she said max is $3000 per day.
[CUSTOMER][NEUTRAL] OK, so for the max 3000 per day, um, it's gonna be up to what?
[AGENT][NEUTRAL] 3000.
[AGENT][NEUTRAL] So it's, it's
[CUSTOMER][NEUTRAL] 3000 per day, but then, and what about for the year or anything like that?
[AGENT][NEUTRAL] Is it
[AGENT][NEUTRAL] There there's no yearly maximum. So this is a gap policy. It's a secondary gap policy. It fills in the gaps that primary doesn't pay for.
[CUSTOMER][NEUTRAL] Really
[AGENT][NEUTRAL] So if if primary pays, if there's like $200 left over from primary, this policy will pick up up to $3000 per day for physical therapy.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And and all kinds of other services too, like outpatient hospital services, ER, but PT is one of the benefits and the benefit is 3000 per day payable after primary processes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Gotta find
[CUSTOMER][NEUTRAL] Oh OK and then you gotta get all the billing information. You gotta get the billing address, the electronic billing, billing fax.
[CUSTOMER][NEUTRAL] Billing address electronic billing and billing fax you gotta get all that right.
[CUSTOMER][NEUTRAL] I have an email address.
[CUSTOMER][NEUTRAL] You gotta get all 4 pieces of information. OK, email you have like a contact.
[CUSTOMER][NEUTRAL] OK, so what would be the billing address?
[AGENT][NEUTRAL] Our claims mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] And did you need the fax number?
[CUSTOMER][NEUTRAL] Um, the fax number as well, yeah.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then we also have a payer ID.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Your ID is 60801.
[CUSTOMER][NEUTRAL] Let me
[CUSTOMER][NEUTRAL] It's 60801 you said?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK and then is there an electronic billing?
[AGENT][NEUTRAL] Yes, the payer ID 60801.
[CUSTOMER][NEUTRAL] That's oh OK.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] And um is there an email?
[AGENT][NEUTRAL] Uh, we don't have an email, no.
[CUSTOMER][NEUTRAL] No, no email.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] OK, I mean I think that's all I need from you.
[CUSTOMER][POSITIVE] OK, perfect, um, give me just a second. OK, yeah, that's all thank you so much.
[AGENT][POSITIVE] OK, thank you for calling APL. Have a great day.
[CUSTOMER][POSITIVE] Thank you same to you bye.