AccountId: 011433970860
ContactId: fc9f11a3-22de-4e06-bf3b-0f15b9608c5c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1274619 ms
Total Talk Time (AGENT): 936458 ms
Total Talk Time (CUSTOMER): 293465 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/fc9f11a3-22de-4e06-bf3b-0f15b9608c5c_20250116T14:40_UTC.wav
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[AGENT][NEUTRAL] For contacting APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Um, yes, good morning. Um, I'm calling cause, um, I'm not quite sure how to use the card, um, for physical therapy. Um.
[CUSTOMER][NEUTRAL] Uh, I use my health insurance card first, correct?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Um, and, and I use the APL card, like for the co-pay and deductible for whatever's left. Is that how that works?
[AGENT][NEUTRAL] Well, that's how some of our policies work. Do you have your policy number so I can look it up and we can be absolutely sure?
[CUSTOMER][NEUTRAL] Um, yeah, it's um
[CUSTOMER][NEUTRAL] How which one is it the in hospital or outpatient?
[AGENT][NEUTRAL] Um, either of those two numbers will get us where we want to be, so that's either one of them will be fine.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Um, I, I'll give you the outpatient cause, I mean, it's a physical therapy, so neither one.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, is it, OK. It's 02510864 M as in Mike L 8.
[AGENT][NEUTRAL] Thank you. If I could verify your name and date of birth and phone number, please.
[CUSTOMER][NEUTRAL] Um, uh, the insured's name or my name?
[AGENT][NEUTRAL] Oh, your name would be fine.
[CUSTOMER][NEUTRAL] OK [PII].
[AGENT][NEUTRAL] And your date of birth and a phone number please ma'am? I just wanna make sure I've got the right policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And my phone number or the insured's phone number?
[AGENT][NEUTRAL] Oh, yours would be fine.
[CUSTOMER][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] I do appreciate that. So, we do show that your policy went into effect on [PII]. It's active. Now, for physical therapy, what you'll do um is you will uh turn in your, your um primary insurance and the secondary insurance. And what we will do, or what will end up happening is that they will file through your major medical first, and then they will file through us. And what we will do is that normally the, the out of pocket that you would pay.
[AGENT][NEUTRAL] We will pick that up up to $2000 for physical therapy. Um.
[AGENT][NEUTRAL] Now, that is, uh, so what you'll end up doing is when you go in to the physical therapy uh clinic, you will go ahead and get, give them both cards, [PII]. You're, you're gonna get hand them both cards and explain to them that you have a secondary insurance. So what they will do is they will take that first card and I, I believe your major medical is United Healthcare. Um, they will file through United first and then they will file through us.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, but that is the way that that is going to go. So you're gonna hand them two insurance cards and let them know that that physical therapy is covered. And what'll probably end up happening is they'll call us, we'll verify that you have insurance, we'll verify that physical therapy is covered. We'll tell them where to send their claim. But that's the way that this is going to work is that whenever you, you, uh, use your secondary insurance, you'll hand them both cards at the same time and explain to them that you've got secondary insurance that covers.
[AGENT][NEUTRAL] Whatever it is that you're going in for. And in this case, physical therapy, and that's the way that you would use these cards. Now,
[AGENT][NEUTRAL] If you should ever decide that you want to file the um insurance yourself, in other words, have the benefit paid to you directly rather than to the provider, um, you'll notice on your card that there is a website [PII]. You can file the claims yourself, and what we'll do then is that we will just pay the benefit to you directly, um, either through direct deposit or through a check.
[AGENT][NEUTRAL] But if you would rather not do that, then, you know, just hand them both cards. Tell them you've got secondary, that uh physical therapy is covered and that is it.
[CUSTOMER][NEUTRAL] OK, so what you mean by that is I pay them out of pocket and then I get a reimbursement from you guys?
[AGENT][NEUTRAL] Well, if you decide that you want to do it that way, um, a lot of times what people will do is they will just, uh, you know, if you, if, if they file if the physical therapy facility files it themselves, then they will be paid the benefit. But sometimes people would rather have the benefit paid to them first and then they pay the provider. So you've got two different ways of getting it, it, it will be done one way or the other, um.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] It just depends on whether you want to pay the uh
[AGENT][NEUTRAL] The provider or the physical therapist at the date of service and then file uh yourself or whether you want them to file the claim.
[AGENT][NEUTRAL] So, it, it can be done either way, whichever way you want to do it.
[CUSTOMER][NEUTRAL] OK. Yeah.
[AGENT][NEUTRAL] But probably the easiest way is just to hand them both cards and let them do it.
[CUSTOMER][NEUTRAL] Yeah, because then I don't have to pay out of pocket and and sometimes you don't have that up front.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] No, I understand.
[CUSTOMER][NEUTRAL] Yeah, like the newer I went to it was like, you know, like 100 something or, no, it was like 250 or something like that. And I was like, less money like that lying and lying around. So I was like, so they gave me a really hard time with this card.
[CUSTOMER][NEGATIVE] And, and they were like, there's nothing to like charge, and what are all these numbers and what do they mean? And I was like, well it's supposed to work? And they kept asking me if they were like, they couldn't fit the number in their system and it, it was, I had a really hard time with it. And, and so I tried to, and you know, it was like I tried to give them all these numbers and my husband had to look up the
[CUSTOMER][NEGATIVE] certificate number and the member ID number which were not on the card. And it, it was like, it was hard to get it to go through.
[AGENT][NEUTRAL] Oh, I'm sorry. Um, normally we don't have that problem.
[CUSTOMER][NEUTRAL] So, that
[CUSTOMER][NEUTRAL] That, yeah, that was.
[CUSTOMER][NEUTRAL] Yeah, yeah. So, I was like, how do we get around something like that?
[CUSTOMER][NEUTRAL] from happening again.
[CUSTOMER][NEUTRAL] So that was, that was uh.
[AGENT][NEUTRAL] Well,
[AGENT][NEUTRAL] I'm showing that someone called. It looks like someone called um.
[AGENT][NEUTRAL] On the [PII] of this month.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, verifying benefits and, uh, but normally what will end up happening is if you're, if you're dealing with someone at the front desk, you're, you're not necessarily dealing with somebody who's doing the insurance themselves, filing it themselves. So what we will do, um, if you ever run into that problem again, uh, you can contact us and then, and then we can call uh the um the provider and uh actually talk to somebody in the billing department.
[AGENT][NEUTRAL] And that's, that is somebody who would know what the gap insurance was, um, and then what we do is we give them your information, um, we give them your, uh, uh, if they need your employer number, um, then we give them that information and we tell them how to submit the claim to us, um, but sometimes if you're, yeah, so if you ever do have that problem again, please just let us know. We can, we will talk to the provider ourselves, um.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] You know, and we can let them know where to sit, you know, what your benefits are.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] They got a call from CMI for my son's, uh, they think he had X-rays done or something like that. So yeah, that, that was probably that call.
[AGENT][NEUTRAL] Well, if you're
[CUSTOMER][NEUTRAL] He's been
[AGENT][NEUTRAL] Oh, I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] X-ray
[CUSTOMER][NEUTRAL] No, that, that was probably all for my son. He's having an MRIs and X-rays done, and then he's gonna have a surgery done. So he's like, he pay all that out of pocket. I'm like, AJ, we have, we have this card, you need to be using it.
[AGENT][NEUTRAL] Oh,
[AGENT][NEGATIVE] Oh, wow. That's, yeah, absolutely. Please do, because you've got up to $2000 for outpatient. And then one hopes that he doesn't have to go to inpatient hospital, but if you, if you do have to spend the night or something or, or is an observation, you've got up to $6000. So, um, but anytime that you're having a problem like that, and, and sometimes it's, um, because insurance for, for everyone, it's just such a nightmare. Um, uh, if you ever have questions like that or the provider ever has questions, you know,
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Uh, please, uh, you know, let us know. We will, uh, uh, if you're there, we will talk to them there. If you need us to call them, we can do that, um, because you've got these benefits, we want you to use them. So if you do have any questions or if they have any questions, we will be more than glad to talk to the provider, let them know what your benefits are, how to submit a claim, how to file the claim. Um, it's usually gap insurance is so common now, um, just because of the cost of, of things.
[AGENT][NEUTRAL] Um, usually, we don't have to explain what the gap insurance is anymore, but if we need to do that, then we'll do it. Uh, so, you know, next time you have that problem, uh, either with, with your son, uh, or, or with this physical therapy, we will be glad to contact them and let them know, uh, and usually that's all that they're looking for, uh, is just, you know, where to file the claim, what are the benefits, you know, will you pay, you know, that's the thing. So, please let us know and we'll, we'll talk to them.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And then, um, a couple more questions is which number do I give them if it's for the physical therapy? Is it the in hospitals or the outpatient?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It doesn't matter because it gets you to the same place. Um, the, the difference is for us when we're filing a claim. So what we are looking at, um, is, uh, those, those two numbers, the only time that they really ever, ever, ever, ever come into play is uh when you're in the hospital for 18 hours or more.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Or you're in the hospital for 17 hours or less. So 17 hours or less is always gonna be outpatient, 18 hours or more will always be inpatient, and it just depends on that, and that's, that's just more for us than it is for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] Confusing.
[CUSTOMER][NEUTRAL] OK, and
[CUSTOMER][NEUTRAL] OK, and then the other question I had is, if the um physical therapy company is out of network with my health insurance, does that matter to APL?
[AGENT][NEUTRAL] Yes, it does. Um, we work in, uh, what we do is, uh, we work because we pay the deductible, co-payment or co-insurance from your major medical. Now, let's just say that um on the uh explanation of benefits uh for uh United Healthcare, it shows that you're out of network and, and the deductible co-payment or co-insurance is zero.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Then there's nothing for us to pay um now sometimes and that you want to check with United if they do this they will have.
[AGENT][NEUTRAL] Reduced benefits, there will still be a deductible co-payment or co-insurance, but it will be reduced because you're out of network. So, um, if, so when you're looking at your explanation of benefits, anytime you, you hand in your United Health card to anybody, like let's just say the physical therapy.
[AGENT][NEUTRAL] Um, in a few days' time, you will get an explanation of benefits from United Healthcare. They must send you one. either way, either that or you can go online to your, to your online portal and you'll see it. And what you're looking for, and it's confusing, but what you're looking for is, is where it says deductible, co-payment or co-insurance.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And if it says 0, then, then we don't, you know, there's 0 for us to pay. If it says, um, if it, if it has a deductible, co-payment or co-insurance, and as long as you haven't used that $2000 per person benefit already, that is what we will pay up to that $2000. Now, um, one of the things that uh you will um notice on your, on your secondary insurance is that we don't pay uh for the office visit. So you will, uh, if you went to your
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Primary physician and you had um uh just an office visit, we won't pay that. If you went to your primary physician, uh, just for a checkup, we don't pay that because we're sickness or accident. But beyond that,
[AGENT][NEUTRAL] Um, as long as you have a deductible, co-payment or co-insurance for outpatient services like the ER, urgent care, that sort of thing, surgery, um, or, uh, the MRI, uh, as long as you have a treatment done in your, in your physician's office, your primary care physician, cancer treatment, uh, independent labs, that sort of thing, and as long as there's a deductible co-payment or insurance, that's where we come in. So always look at that EOB and make sure that it doesn't just say zeros if you're going out of network.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Does that make sense? Did I, did I, is there, I mean, because it's, yeah.
[CUSTOMER][NEUTRAL] Well if it's
[CUSTOMER][NEGATIVE] Like a checkup, then it's not covered.
[AGENT][NEUTRAL] It is not covered because it, but if it's a sickness or accident, yeah.
[CUSTOMER][NEUTRAL] But it
[CUSTOMER][NEUTRAL] Uh, if it's a treatment.
[CUSTOMER][NEUTRAL] Than it is.
[AGENT][NEUTRAL] Sure, like allergies or um, you know, uh, I don't know, uh, if, if you go in, um, you know, if, if there's something going on, if, if, if, if your son [PII] needs a, a checkup after, after his surgery, um, if, if this is being done through his primary care physician. Let's to say that it is. And you went in for a checkup just to, just to see how that
[AGENT][NEUTRAL] You know, what, how the, the surgery uh went. Um, what he's doing is he's going in not as just not as preventative health, not just it's a wellness check. They're checking on, on, you know, on an issue, on a diagnosis and the diagnostic test where they, yeah.
[CUSTOMER][NEUTRAL] It's supposed
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] So that that would be covered because it's post-op, right?
[AGENT][NEUTRAL] Absolutely, because it's something that it's not just that wellness check. Um, it's something that, you know, they're looking to see that he's still all right after that surgery. So, um, and all of this adds up to $2000 per person, um, per family member.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Uh, but again, if you ever have any questions like with the um with the provider if they're ever asking you about your gap insurance, you can always file that claim yourself and we will walk you through the process if you ever want to do it yourself. Um, you know, we'll even, if you, you know, if you go online, we'll even stay on the phone with you while you're signing up to go online. Now I can't, I can't look up your, your, uh, username or your password, but we will help you through the process of going online so if you ever need to, but.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] If you ever have questions with the provider, the provider ever has questions, just have them call us or we will call them.
[AGENT][NEUTRAL] And you know, that way, because you've got this, you need to use it, you know, so.
[CUSTOMER][NEUTRAL] And then, um, that, that brings me to another question cause we, even though we were told by
[CUSTOMER][NEUTRAL] The surgeon that my daughter wasn't covered, she just had dental surgery and we were told she wasn't covered by APL.
[AGENT][NEUTRAL] Now, um, is this, uh,
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Dental surgery is not covered.
[AGENT][NEUTRAL] No, no, that's, that is uh slightly different, um.
[AGENT][NEUTRAL] So for wisdom teeth, dental surgery, that sort of thing, that, that type of thing is not covered, um, but, um, let's just say, heaven forbid.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] But I had this, uh, happened with my own daughter. She was in a car wreck and she had dental damage.
[AGENT][NEUTRAL] It was an accident. That is covered. So as long as it's an accident or degenerative, you know, that we will always review that so that to see if it can be paid.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] So if it's heaven forbid that that should ever happen, but it, it's um but for the wisdom teeth, for the dental surgery, that is a, that's a totally different thing and it's, that's insurance wise it's considered different, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] So that is not covered.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. And one of them was an, it was a supernumerary. It was, uh, she had a cyst.
[CUSTOMER][NEUTRAL] She had a 5th
[CUSTOMER][NEUTRAL] A2.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] I, it's, it's a different how to I know I always.
[AGENT][NEUTRAL] I never know, I, I, and I always feel like I'm listening, um.
[AGENT][NEUTRAL] I would send that whenever, whenever in doubt, always send in the claims.
[AGENT][NEUTRAL] Because when we're looking at these claims, we're looking at them to see if there's anything within your policy.
[AGENT][NEUTRAL] They can be paid.
[AGENT][NEUTRAL] Um, so I would always, you know, I would just make it routine, hand them two cards, and if there's any other questions, you know, just say yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me call APL, uh, let me call customer service. Let me call the, the claims department, um.
[AGENT][NEUTRAL] And uh it doesn't matter which number you give us, uh, inpatient or outpatient, we'll always find your, your information. And you know, when in doubt, I would just send the claim in and let us look at it because we're, we will look at it and see and if there's a way for it to be paid through your policy, we will do it. And sis, I mean, usually that's, that's, you know, we, we will be glad to look at that and see what, what is going on. Just, just remember that the office visits are not covered.
[AGENT][NEUTRAL] Excuse me.
[CUSTOMER][NEUTRAL] Right, and, and sending it in like what, what is it that I would be sending in?
[AGENT][NEUTRAL] Well, whenever you're um
[AGENT][NEUTRAL] It sometimes whenever you go into the doctor's office, they give you what is called a walking out paper.
[AGENT][NEUTRAL] And it's uh it's that paper that they give you, uh, you know, that says all the, you know, the diagnosis code and the blah, blah blah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then we will need.
[AGENT][NEGATIVE] Yes, because we were secondary, we will need the explanation of benefits from United. Now we can never ask United for that EOB, OK? They will never give it to us because we're not their client.
[AGENT][NEUTRAL] So we.
[CUSTOMER][NEUTRAL] So I see it
[AGENT][NEUTRAL] Yeah, yeah. So we'll, you'll always need to send in that EOB and let's just say that you don't have the walking out papers or the walking out papers don't, don't tell you what, don't tell us what's going on. Um, you can just write on there. Uh, I took my daughter in um because she had a cyst.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh, you can just write it down and we will look at the diagnosis code. So the, so the things that you will need, we will always need, always, always, always, always, the explanation benefits from United Healthcare.
[AGENT][NEUTRAL] We always need to know what the visit is for. Now, we realized that you're not, you know, uh, you don't, you're not gonna be looking up the diagnosis code and, and that's fine. So you can just tell us what it's for.
[AGENT][NEUTRAL] You can just say to us, hey, we, we took, uh, we went in for physical therapy, or we went in because uh someone sprained their ankle or something, you know, this, um.
[AGENT][NEUTRAL] Just tell us, just write down on there. You can even write it down on the EOB just let us know so that we'll look up the diagnosis code. And then if you've got the um itemized bill, we want that as well. Uh and um that way when you, when you download it into the portal, um uh we will have all the information that we need and we don't have to send you back another explanation saying hey we need this. You know, we don't want to pin these things, we want to be able to go ahead and and get them through and and and process them.
[AGENT][NEUTRAL] Um, so that's the things that you always needed that EOB.
[AGENT][NEUTRAL] Um, itemized bill if you've got it, and what the visit was for, and always look at the EOB to make sure that it actually shows a dollar amount.
[AGENT][NEUTRAL] For the deductible, co-payment or co-insurance.
[AGENT][NEUTRAL] And, and the ELBs, when you get those, they're like pages long, but you're looking at the one that shows that and it even shows it in a grid, deductible, co-payment or co-insurance.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And if you have any questions when you're sending them in just just submit it and we'll go on the, you know, because we can see it in real time we'll go online and look at it and say oh well yeah you need this or oh no this looks good we'll take care of it.
[AGENT][NEUTRAL] So
[AGENT][POSITIVE] You know, we'll walk you through it if if that's what you want to do, if you want to turn it in yourself, which is great, if not, just if you have any questions with the provider again, you know, just have them call us.
[CUSTOMER][POSITIVE] OK, all right, that's good to know.
[AGENT][NEUTRAL] Now, is there any other questions that you have about your policy, um,
[CUSTOMER][NEUTRAL] I have a lot, right?
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Uh, no, no, you're very helpful. Thank you so much.
[AGENT][NEUTRAL] OK. Well, if you do have any other questions, just let us know. Um, if you do decide to uh submit a claim yourself, let us know. Uh, we'll stay on the phone with you as you, as you download it. We'll look it up, the, the documentation. But if you ever have questions again like this physical therapist, please have them call us or if you're there at the, at the office, we'll talk to them while you're, while we're all on the phone and we can go over it and make sure that they know what it takes to get that, you know, get it turned in.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK,
[CUSTOMER][NEUTRAL] Definitely. Thank you. And, and, and that's good to know for the future if, if I stumble with that again cause I, I, I would know that last time because it was a pain.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Of course, we'll
[AGENT][POSITIVE] OK, well, thanks, yeah, well, thanks for contacting us. Thanks for contacting ATL and if you have any other questions, just let us know. Otherwise, uh you have a very good, a very good day and always call us if you have any questions.
[CUSTOMER][POSITIVE] Alright you have a good day too thank you.
[AGENT][NEUTRAL] Mhm.