AccountId: 011433970860
ContactId: f4b2375a-2ea7-4a79-aaea-458fdc9bcb85
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 276829 ms
Total Talk Time (AGENT): 146009 ms
Total Talk Time (CUSTOMER): 88262 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/f4b2375a-2ea7-4a79-aaea-458fdc9bcb85_20250130T19:38_UTC.wav
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[AGENT][POSITIVE] Good afternoon thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm just calling regarding benefits, um eligibility for this member.
[AGENT][POSITIVE] Well, [PII], it would be my pleasure to assist you with eligibility and benefits. What is the callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII], and what is the policy number for the patient?
[CUSTOMER][NEUTRAL] 994-466.
[AGENT][NEUTRAL] And the patient's name and date of birth, please.
[CUSTOMER][NEUTRAL] Uh, the patient is [PII]. Uh, the insured, um, subscriber is [PII], um, but [PII], uh, her date of birth is [PII].
[AGENT][POSITIVE] All right, thank you.
[AGENT][NEUTRAL] So I'm checking this policy. This policy turned on 8-1-2020, looking to see if they have active coverage. So bear with me just one second.
[AGENT][NEUTRAL] And this is for [PII]. Let me see if [PII] is listed on this policy. I do see an active policy, and I can give you that information.
[CUSTOMER][NEUTRAL] Sure, what is that?
[AGENT][NEUTRAL] As of [PII], the active policy number for [PII] is 191.
[AGENT][NEUTRAL] 2866.
[CUSTOMER][NEUTRAL] OK, and now this policy, um, does it cover, uh, for like as a supplemental, does it cover any copays that they would have?
[AGENT][NEUTRAL] It is a secondary policy to the major medical of the policyholder.
[CUSTOMER][NEUTRAL] And would it cover a copay or would only cover like the the co-insurance?
[AGENT][NEUTRAL] I'm getting that pulled up bear with me. Is this for an office is it?
[CUSTOMER][NEUTRAL] Well, OK.
[CUSTOMER][NEUTRAL] This is for physical therapy in the outpatient uh facility.
[AGENT][NEUTRAL] OK. So she does have coverage for physical therapy facility.
[AGENT][NEUTRAL] And that is under, mhm.
[CUSTOMER][NEUTRAL] In in a hospital setting?
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] That is the benefit amount is up to $250 per calendar I'm sorry, per calendar day that we can pay toward the deductible, co-pay, or co-insurance.
[AGENT][NEUTRAL] Now that is a verification of coverage and not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh what about the claims billing address? is it still [PII]? No, he's got an old card.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No, that changed too. He's got a very old car. Let me give you our claim submission information.
[CUSTOMER][POSITIVE] Sure, no problem.
[AGENT][NEUTRAL] The um mailing address for claims is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] We also have a payer ID or a claims fax number which if you would like those as well.
[CUSTOMER][NEUTRAL] OK, and the payer ID is?
[AGENT][NEUTRAL] 60801
[CUSTOMER][NEUTRAL] And uh claims fax number?
[AGENT][NEUTRAL] 877.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And [PII] for claim submission, we will need the primary EOB along with the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][MIXED] OK, um, but the phone number was correct on the card.
[AGENT][POSITIVE] The phone number is good.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Uh, excellent.
[AGENT][NEUTRAL] Yeah, he just needs to call us or, or make sure that they change out that card.
[CUSTOMER][NEUTRAL] OK and um and then do you have a reference number for the call or?
[AGENT][NEUTRAL] A reference number is my name and today's date.
[CUSTOMER][NEUTRAL] OK, and you said [PII], right?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK alright well thank you so much you have a great day.
[AGENT][POSITIVE] Oh it's still my pleasure and thank you for calling APL. I hope you have a wonderful day as well. Take care.
[CUSTOMER][POSITIVE] Thank you bye.
[AGENT][NEUTRAL] Bye bye.