AccountId: 011433970860
ContactId: d9f749c9-eb64-482d-a5bc-530b48bb0d81
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 409000 ms
Total Talk Time (AGENT): 158175 ms
Total Talk Time (CUSTOMER): 130538 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/d9f749c9-eb64-482d-a5bc-530b48bb0d81_20250303T13:54_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from the protest office checking eligibility and benefits.
[AGENT][POSITIVE] OK, I'll be more than happy to assist you with the eligibility and benefits, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it is [PII] and it is a direct line or extension.
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, the member ID I have here it is 02488772.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm, may I have your name please? I missed your name.
[AGENT][NEUTRAL] Sure, my name is [PII] [PII].
[CUSTOMER][POSITIVE] Thank you. Thank you, [PII].
[AGENT][NEUTRAL] You're welcome. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Just the member's name is [PII] and the date of birth it is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. I am showing the policy is active. It's been effective since [PII]. And what type of benefits did you want to go over today?
[CUSTOMER][NEUTRAL] I, I need physical therapy benefits for the member for an outpatient service done in office.
[AGENT][NEUTRAL] OK, you said in office?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so for physical therapy, the policy would, well, for outpatient, the policy would pay up to $3150 per covered person.
[AGENT][NEUTRAL] Um, that does include occupational, I'm sorry, physical therapy in a physical therapy facility or physician's office.
[AGENT][NEUTRAL] Did you want me to see if any of the max has been used for this year?
[CUSTOMER][NEUTRAL] Yes, before that, could you please check, uh, tell me whether it is for the deductible or the or for the out of pocket max? You said it is $3150 right? Is it for the deductible or out of pocket max?
[AGENT][NEUTRAL] This is a secondary insurance. We pay towards the copay, deductible and co-insurance after primary.
[AGENT][NEUTRAL] Up to that max of $3150.
[CUSTOMER][NEUTRAL] So it is the deductible, right?
[AGENT][NEUTRAL] We pay towards the deductible, co-pay, and co-insurance after primary, so it can be it can be all three.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] So it is a dollar limit sorry.
[CUSTOMER][NEUTRAL] Because it is a dollar limit you pay, right?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] So it is the limit you pay, right?
[AGENT][NEUTRAL] Whatever is sent over to us after primary, we, we can pay towards those three things up to $3150 a year. So it can be one or all.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK, I got it. Could you please check, is there any specific deductible out of pocket max, co-pay, or coincidence?
[AGENT][NEUTRAL] This this is their secondary policy. We don't apply it, we help pay it if primary applies it.
[CUSTOMER][NEUTRAL] OK, I got it.
[CUSTOMER][NEUTRAL] So whatever uh
[CUSTOMER][NEUTRAL] Denied from the primary.
[CUSTOMER][NEUTRAL] Uh, whatever removed from the primary you pick and cover up to $350 right?
[AGENT][NEUTRAL] Right, if primary does not apply, we cannot apply to the claim either.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Is there any limit?
[AGENT][NEGATIVE] Um, there's no visit limit and there also has been, um, none of the max used for this year.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, can you please check for the
[CUSTOMER][NEUTRAL] Plan name. What's the plan name? May I have the plan name, please?
[AGENT][NEUTRAL] This is their Medlink supplemental gap insurance.
[CUSTOMER][NEUTRAL] Midlink right?
[AGENT][NEUTRAL] Yes, sir. Mhm.
[CUSTOMER][NEUTRAL] Mid link, uh, supplemental medical policy.
[CUSTOMER][NEUTRAL] Do you have any group group for this plan?
[AGENT][NEUTRAL] Hold on one moment, I sure do.
[AGENT][NEUTRAL] The group number is 261-777.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Uh, thank you, [PII]. And could you please check, uh, what insurance is listed as primary for this number?
[CUSTOMER][NEUTRAL] Could you, could you check for the name of the insurance which is listed as primary?
[AGENT][NEUTRAL] I understand. Give me just a moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Primary insurance is Allstate.
[AGENT][NEUTRAL] Slash Cigna.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] For the major insurance carrier, it says Allstate slash Cigna.
[CUSTOMER][POSITIVE] Thank you. I got it. Thank you, [PII]. Uh, so,
[CUSTOMER][NEUTRAL] So authorization and the referral is also uh same as primary right if only primary needs authorization uh secondary gap is also needs authorization, right?
[AGENT][NEUTRAL] There's
[AGENT][NEUTRAL] No, there's no there's no um authorization or pre-cert required for the secondary insurance.
[CUSTOMER][POSITIVE] Thank, thank you. Thank you, [PII], thank you for assistance. I hope I got all the details that you need for this number. Shall I get the call reference number for this call whenever you're ready?
[CUSTOMER][NEUTRAL] And uh sorry I missed to get the claim's mailing address. Can I have the claims mailing address, please?
[AGENT][NEUTRAL] The claim's mailing address is [PII].
[AGENT][NEUTRAL] [PII] City, [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] You have the payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] Thank you. What's the name for this address to whom we need to bill?
[AGENT][NEUTRAL] APL claims department.
[CUSTOMER][NEUTRAL] APL claims. Thank you. Thank you. Thank you and thank you for assistance whenever you're ready, shall I get the card reference number for this call?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you. Thank you for assistance. Have a great day. Bye-bye, take care.
[AGENT][POSITIVE] Wow.
[CUSTOMER][NEUTRAL] Mhm.