AccountId: 011433970860
ContactId: 0e0d8c1f-08e7-4d9c-b095-52985f1512a3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 336200 ms
Total Talk Time (AGENT): 146637 ms
Total Talk Time (CUSTOMER): 122449 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/0e0d8c1f-08e7-4d9c-b095-52985f1512a3_20250121T14:14_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is. How may I help you?
[CUSTOMER][NEUTRAL] Hi, uh, this is [PII]. I'm calling from the provider's office. Um, I'm just calling to verify benefits for one of our patients.
[AGENT][POSITIVE] OK, well, I can definitely help you with the benefits, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, that's going to be [PII]. I have [PII].
[AGENT][POSITIVE] Thank you for that. And may I
[CUSTOMER][NEUTRAL] If
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What's your name again?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][POSITIVE] Thank you [PII].
[AGENT][NEUTRAL] You're welcome. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] OK. Sure. I have 01481596 M for Mary, L for Lima, number 8.
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. Can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][POSITIVE] Thank you for that.
[AGENT][NEUTRAL] So I'm showing that the policy is active. It's been effective since [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what type of benefits did you want to go over today?
[CUSTOMER][NEUTRAL] Um, I wanna, I wanna ask if this patient has deductible and out of pocket in a physical therapy benefits specifically.
[AGENT][NEUTRAL] OK, so this is their secondary insurance, so there's no deductible, um.
[AGENT][NEUTRAL] And hold on one moment. I'm pulling up the benefits now. You said, hold on one second.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Supplemental plan, right?
[AGENT][NEUTRAL] Yes, it's a supplemental gap insurance, so there's no out of pocket or deductible. Now, if the major insurance charges that, we assist with those payments. Our policy pays towards the copays, deductible and co-insurance after primary.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what type of benefit did you say you were looking for?
[CUSTOMER][NEUTRAL] Physical therapy.
[AGENT][NEUTRAL] OK, hold on one moment. I'm waiting for the policy to populate here.
[CUSTOMER][NEUTRAL] Ah
[CUSTOMER][NEUTRAL] Sure
[AGENT][NEUTRAL] OK, so for outpatient, the policy will pay up to $500 per calendar day.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That does include physical therapy and a physical therapy facility.
[CUSTOMER][NEUTRAL] Alright, that's $500.
[AGENT][NEUTRAL] If it is considered
[CUSTOMER][NEUTRAL] Per per year?
[AGENT][NEUTRAL] Per calendar day?
[CUSTOMER][NEUTRAL] Oh, per day, OK.
[AGENT][NEUTRAL] If the treatment is done in the office, she also has the office treatment rider.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, this would be uh outpatient hospital.
[AGENT][NEUTRAL] As long as it
[AGENT][NEUTRAL] OK, so then the, the physical, if it's in an outpatient hospital like a physical therapy facility?
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] So, yes, that would just be under the regular outpatient benefits.
[CUSTOMER][NEUTRAL] OK, that's $500 per calendar year, correct?
[AGENT][NEUTRAL] $500 per calendar day.
[CUSTOMER][NEUTRAL] OK, per day, OK.
[CUSTOMER][NEUTRAL] No authorization or referral because you'll be acting as a secondary, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Is there like a limit?
[AGENT][NEUTRAL] 2
[CUSTOMER][NEUTRAL] Uh, like the visiting or the, the benefits of 500 per calendar day?
[AGENT][NEUTRAL] $500 per calendar day is the limit. So whatever claims come in for a date of service, we would pay out if we can up to $500 per day.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] OK, and how about the claim address should we submit should we submit it to a different claim address?
[AGENT][NEUTRAL] A different claims address then which one do you have?
[CUSTOMER][NEUTRAL] I don't have a claim address for you like I'm talking about.
[AGENT][NEUTRAL] OK, so the
[CUSTOMER][NEUTRAL] Sure, go ahead.
[AGENT][NEUTRAL] Are you asking me for the claim's mailing address? You said a different one, so I didn't know what you were comparing it to.
[CUSTOMER][NEUTRAL] Oh no, I thought they're gonna send it to the primary and the primary will consolidate with you so what's the claim address?
[AGENT][NEUTRAL] So no, the
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] I got [PII].
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Thank you and [PII], may I have a call reference number for this call?
[AGENT][NEUTRAL] So there's no call reference number, you can use my name in today's date?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, thank you, that's [PII].
[CUSTOMER][POSITIVE] OK, thank you so much for taking my call today, [PII].
[AGENT][POSITIVE] You're welcome and thanks for calling APL. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] I don't think so thank you so much. Have a good day.
[AGENT][POSITIVE] You're welcome. Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.