AccountId: 011433970860
ContactId: 091174df-867a-4663-998f-90e7c80d4127
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 219320 ms
Total Talk Time (AGENT): 104442 ms
Total Talk Time (CUSTOMER): 95395 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/06/091174df-867a-4663-998f-90e7c80d4127_20250606T13:25_UTC.wav
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[AGENT][NEUTRAL] APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi [PII]. My name is [PII] calling from Select Physical Therapy, and I was calling to verify um OT benefits please.
[AGENT][POSITIVE] All right, I'm happy to verify benefits. Do you have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, I have a patient's policy number as um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 02
[CUSTOMER][NEUTRAL] 346-765 ML 8
[AGENT][POSITIVE] Thank you, let me just pull this up.
[AGENT][NEUTRAL] And then for documentation do you have a good call back number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, [PII]. And then what's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yes, the patient's name is um [PII].
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] The patient's date of birth is [PII].
[AGENT][NEUTRAL] Thank you. So [PII] is active. Uh, the effective date on here is [PII]. We're the members secondary insurance, so this covers deductible, co-pay, co-insurance, so the primary does not.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Their outpatient benefits on this plan are a max per calendar day, and that is $500.
[CUSTOMER][NEUTRAL] OK, so the patient had a concern. He stated that he spoke to someone and they said that it doesn't cover OT physical therapy, and that's the reason I wanna confirm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, let me just, I got the policy pulled up here. Give me just a second, you want, I'm gonna double check here.
[CUSTOMER][POSITIVE] Sure, no problem.
[AGENT][NEUTRAL] I should say.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so just to confirm, [PII], it does state that under the physician covered charges, physical therapy is not an included charge and neither is a physician office visit fee.
[CUSTOMER][NEUTRAL] OK, and that's also cover OT therapy too.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, so, OK, so OT and PT benefit is not a covered benefit under his plan.
[AGENT][NEUTRAL] From what it states, correct. It's not an included charge.
[CUSTOMER][POSITIVE] Oh OK alright thank you [PII], um.
[AGENT][POSITIVE] Yeah, you're welcome.
[CUSTOMER][NEUTRAL] OK, and may I have a reference number for this call, please?
[AGENT][NEUTRAL] Absolutely. Call references my name with today's date. My name again is [PII], that's spelled [PII] Last initial to my name is gonna be [PII] and then today's date.
[CUSTOMER][NEUTRAL] OK, [PII], one more thing. OK, so the reason why I called is because he's right now being seen for occupational therapy, which we know that's not a covered benefit, but he says that uh he was advised by a previous rep that PT is covered but not OT. So I just want to clarify that if it's like as well as PT and OT because he's gonna be seen for his OT, but
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] A PT is not covered, then
[AGENT][NEGATIVE] Yeah, I mean, it states in the policy certificate it's not a covered benefit. I mean, he can always submit the claims. The worst that'll happen is it's just denied, you know, we'll never tell anybody not to submit it, but it says it's not covered.
[CUSTOMER][NEUTRAL] Because
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] PT and OT not covered.
[AGENT][NEUTRAL] Yes, ma'am. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, thank you [PII]. I'll let him know.
[AGENT][NEUTRAL] You're welcome, [PII]. Uh-huh. Bye-bye.