AccountId: 011433970860
ContactId: 00c6c251-3a5f-4509-9519-8065bdb83f56
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 292779 ms
Total Talk Time (AGENT): 109772 ms
Total Talk Time (CUSTOMER): 137579 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/07/00c6c251-3a5f-4509-9519-8065bdb83f56_20250207T19:06_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi, good afternoon. My name is [PII] and I'm calling from Functional rehabilitation.
[CUSTOMER][NEUTRAL] Um, so the reason for my call, ma'am, is, uh, a patient present, um, her insurance card, I mean her secondary to me, uh, just now, and her, she had an appointment with us yesterday, um, we're not, um, so I wanted to know if, uh, maybe you can check to see if, I mean, I don't believe we take her insurance, her secondary because it says here for in hospital and outpatient, and we're a physical therapy, um, facility.
[AGENT][NEUTRAL] OK, yeah, we can check it. What's your policy number?
[CUSTOMER][NEUTRAL] OK, thank you so much. Um, let's see here. Policy number is 1188043 M for Mary, L for Lima, and 5.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And then if I could get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, it's [PII] and her date of birth.
[CUSTOMER][NEUTRAL] Mm, come on.
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So, the patient does have an active plan. It looks like it is a different policy number. Would you like to take that down?
[CUSTOMER][NEUTRAL] OK, what is that policy number?
[AGENT][NEUTRAL] That policy number is gonna be 021559.
[CUSTOMER][NEUTRAL] Oops sorry.
[CUSTOMER][NEUTRAL] I'm so sorry, you said 02?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] 0215.
[AGENT][NEUTRAL] 5990.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, so let me see.
[AGENT][NEUTRAL] It looks like the member's plan does actually cover um physical therapy and physician's office.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let me see what the outpatient amount is.
[AGENT][NEUTRAL] So the outpatient benefit max on this plan is a calendar day which is $500. We're the secondary so we pick up any deductible, co-pay or co-insurance that the primary does not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'll just have to add this insurance information. OK, now, um, so the patient, I think she was getting treated in um in.
[CUSTOMER][NEUTRAL] In hospital, um, I'm not sure, sorry. Um, I, one of the doctors mentioned that the patient was actually going into, she was, um, she went for an eval somewhere else and we did make her aware that she needs to.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] Have a discharge versus her coming to see us because she was, she did come in and she cannot have to physical therapy at once.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Two different locations.
[CUSTOMER][NEUTRAL] OK. OK, so she does have physical therapy and this um her secondary.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, alright.
[CUSTOMER][NEUTRAL] And you say you guys pick up 500?
[AGENT][NEUTRAL] Right, a calendar day, that's the most it's gonna pick up per calendar day.
[CUSTOMER][NEUTRAL] OK, so but now if she had a uh a visit already elsewhere.
[CUSTOMER][NEUTRAL] Um, how would that work because I mean.
[CUSTOMER][NEUTRAL] I'm sure it was 500 her eval.
[AGENT][NEUTRAL] Yeah, but it's per day. So it's uh every day, the, the insured has that amount. So on that day,
[AGENT][NEUTRAL] If they were seen for an eval.
[AGENT][NEUTRAL] Um, if it was $200 the next day they still have $500.
[CUSTOMER][NEUTRAL] OK, oh, so it's $500 per day like every single time she comes in. Oh, OK, I'm sorry, I was thinking of calendar year $500 per calendar year.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No, no, no, it's per day.
[CUSTOMER][NEUTRAL] OK, so she has 500 per day. OK, and I'm so sorry, can I please have your name?
[AGENT][NEUTRAL] Yeah, absolutely. My name is [PII], that's [PII] and the last initial, my name is [PII]. That's the call reference.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh, OK, that's the call reference OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank you so very much for your help, [PII].
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye