AccountId: 011433970860
ContactId: 0a161642-a61e-420c-9dfd-790082802a5a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 398380 ms
Total Talk Time (AGENT): 172797 ms
Total Talk Time (CUSTOMER): 123982 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/0a161642-a61e-420c-9dfd-790082802a5a_20250410T13:16_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Oh hi, [PII]. My name is [PII] calling from office on a recorded line. I'm calling regarding to check eligibility and benefits for physical therapy service. Can you please help me with that?
[AGENT][NEUTRAL] OK, you're needing eligibility and benefit information for physical therapy?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Ouch, is that correct?
[AGENT][POSITIVE] Yes, I can help you. And what is your callback number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Callback number will be [PII].
[CUSTOMER][NEUTRAL] I have it.
[CUSTOMER][NEUTRAL] Billing cases with me and I want to verify status.
[AGENT][POSITIVE] OK thank you and
[AGENT][NEUTRAL] Rog, what is the patient's policy number?
[CUSTOMER][NEUTRAL] Uh, member ID would be 016.
[CUSTOMER][NEUTRAL] 60259
[CUSTOMER][NEUTRAL] M as in Mike. L as in Lima, 8.
[CUSTOMER][NEUTRAL] 249.
[AGENT][NEUTRAL] OK, thank you, one moment.
[CUSTOMER][NEUTRAL] 06892.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And Ro, any information that is provided will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, ma'am, my name is [PII].
[CUSTOMER][NEUTRAL] And the the will be [PII].
[CUSTOMER][NEUTRAL] Oh
[AGENT][POSITIVE] Thank you. [PII] what year?
[AGENT][NEUTRAL] What is the year?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] You kind of.
[AGENT][NEUTRAL] OK, so I do show that she is the subscriber on this, uh, excuse me, on this supplemental policy.
[AGENT][NEUTRAL] La
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] It is active with an effective date [PII], no termination date.
[CUSTOMER][NEUTRAL] But I don't have that.
[AGENT][NEUTRAL] And her her.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Her outpatient benefit.
[AGENT][NEUTRAL] Max
[AGENT][NEUTRAL] Per calendar year for covered outpatient service.
[AGENT][NEUTRAL] This is $5000 and they're patient deductible.
[CUSTOMER][NEGATIVE] Uh, sorry, I didn't get that your voice is cutting me out.
[AGENT][NEUTRAL] Now, because this is
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello. Can you please repeat deductibles and out of pocket?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] [PII], are you able to hear me?
[CUSTOMER][NEUTRAL] Yes, now I can. Uh, can you please repeat the deductible and out of pocket max amount?
[AGENT][NEUTRAL] OK, there the outpatient benefit maximum on this supplemental policy is $5000 per calendar.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] year for covered outpatient services, no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Uh, it's only the deductible amount would be $5000 and the net amount.
[AGENT][NEGATIVE] No, so that's, that is not correct. I said the maximum benefit amount for covered outpatient services is $5000.
[AGENT][NEGATIVE] And there is zero deductible.
[CUSTOMER][NEUTRAL] OK. It's for maxim.
[CUSTOMER][NEUTRAL] Mhm. Not it.
[AGENT][NEUTRAL] This is the supplemental policy. This is not her primary insurance.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mhm. And is it supplemental policy, may I know the plan type? Is it fan or uh?
[AGENT][NEUTRAL] The name of the supple policy is Edin, M E D L I N K.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] And then if you do submit a claim to APL for this member, we will also have to have a copy of the primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] And once we have processed our claim launch here at APL.
[AGENT][NEUTRAL] We do have a portal that you should be able to check claim status and our portal website is located as secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And yeah, I do have a CPT code. Can you please check authorization is required or not?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] There's no, I'm sorry, you're wanting to verify if certain CPT codes are are covered?
[CUSTOMER][POSITIVE] Yes, yes. Yes.
[AGENT][NEUTRAL] OK, so no, so I wouldn't be able to do that. This would follow her primary insurance, so that is why we will have to have a copy of her.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. Yes, got it.
[AGENT][NEUTRAL] And you submit the claim for review.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And uh may I know your last name?
[AGENT][NEUTRAL] [PII], and yours?
[CUSTOMER][NEUTRAL] Uh, [PII]. And also, may I know the call reference number for this call?
[AGENT][NEUTRAL] My name and today's date.
[CUSTOMER][POSITIVE] Got it. Oh, thank you, [PII]. Thank you for assisting me and have a nice day.
[AGENT][POSITIVE] Well, you're welcome. Yes, [PII]. Well, I hope you have a nice day too, and if that's all I can help you with, and thank you again for calling APL.
[AGENT][NEUTRAL] Bye bye.