AccountId: 011433970860
ContactId: 19ffd4b2-97ce-45e7-83fc-8a010dc736f9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 454739 ms
Total Talk Time (AGENT): 198964 ms
Total Talk Time (CUSTOMER): 138453 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/21/19ffd4b2-97ce-45e7-83fc-8a010dc736f9_20250221T16:24_UTC.wav
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[AGENT][NEUTRAL] And thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, good morning. I'm calling because I need benefits for a patient and sorry I didn't hear your name.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome. So do you also need eligibility or only benefits?
[CUSTOMER][NEUTRAL] Yes, both.
[AGENT][NEUTRAL] Both.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And the member's policy number, please, Ada.
[CUSTOMER][NEUTRAL] 0188794 MLH
[AGENT][POSITIVE] Thank you, one moment please.
[AGENT][NEUTRAL] OK. Give me the policy number because either I, I may have just misheard you or we were missing a number.
[CUSTOMER][NEUTRAL] Or she gave me the wrong, yeah, that usually happens to me. 01.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] 88794 MLH
[AGENT][NEUTRAL] OK. So, yes, ma'am, we're missing a number in that policy number.
[AGENT][NEUTRAL] Do you have a copy of her ID card?
[CUSTOMER][NEUTRAL] No, no, because she hasn't come in yet, she just said it over the phone.
[AGENT][NEUTRAL] OK, do you have
[CUSTOMER][NEUTRAL] Let me see if I can get, can you, you want, you wanna hold on one second, see if I can get her on the other line?
[AGENT][POSITIVE] Uh, sure, that will be fine. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, thank you, hold on.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][POSITIVE] Thank you for calling Select Physical Therapy, where we help our patients get back to activity, work, and everyday life.
[CUSTOMER][NEUTRAL] Select Physical therapy is part of Select Medical, one of the nation's largest employers of physical therapists and other related specialists.
[CUSTOMER][NEUTRAL] Our national network of physical therapy outpatient centers comprised more than 1100 centers in 32 states and the District of [PII].
[CUSTOMER][NEUTRAL] Our brands include Novacare Rehabilitation, Select Physical Therapy, Quart, Saco Bay Orthopedic, and Sports Physical Therapy, Kessler Rehabilitation Center, SSM Physical Therapy, Baylor Rehab's Outpatient Services, and Emory Rehab's Out.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, ma'am. I'm here.
[CUSTOMER][NEUTRAL] Right, yes, uh, he, no, he didn't pick up. He, I have to leave a message.
[AGENT][NEUTRAL] OK, so, um, do you happen to have the full social for the primary policy holder?
[CUSTOMER][NEUTRAL] No, what, what I have is uh
[CUSTOMER][NEUTRAL] Name, last name, address, phone number, date of birth.
[AGENT][NEUTRAL] I can try to search by the.
[CUSTOMER][NEUTRAL] That's what we ask. We don't ask for the social.
[AGENT][NEUTRAL] Yes, ma'am. I can try and search by the name, but if it's a common name and we don't have any other information without a valid number, I don't know that I can locate it, but I will certainly try. What's the last name of the patient?
[CUSTOMER][POSITIVE] OK. OK, thank you.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And the first name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, so, um, I may have located a policy. What is the?
[AGENT][NEUTRAL] First off, any information that is provided would be a verification of benefits and not a guarantee of payment. What is his date of birth?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, so I have located him. He's the spouse of the subscriber on this policy and the correct policy number should be 01.
[AGENT][NEUTRAL] 88
[AGENT][NEUTRAL] 7294.
[CUSTOMER][NEUTRAL] The 2 is missing. OK.
[AGENT][NEUTRAL] Mhm. Yes, ma'am.
[AGENT][NEUTRAL] And again this supplemental policy you're welcome is active effective [PII] and what type of benefit information do you need for him inpatient, outpatient or office?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] It's gonna be for outpatient physical therapy and office setting.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So he has an outpatient benefit maximum of $500.
[AGENT][NEUTRAL] I'm sorry, no, that is not correct. The outpatient benefit maximum on this supplemental policy is $4000 per covered person per calendar year for covered outpatient services, and there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] Uh-huh
[CUSTOMER][NEUTRAL] OK, let me ask you something else, um.
[CUSTOMER][NEUTRAL] Just wanna make sure that physical therapy is covered.
[AGENT][NEUTRAL] He does have an office treatment writer on his policy in which we can review treatment rendered in the office under.
[AGENT][NEUTRAL] This outpatient benefit that I have given you. However, office, if there's any office visit charge, there wouldn't, that would not be covered. Office visits are not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the follow-up treatments are covered, the treatments.
[AGENT][NEUTRAL] I can't guarantee payment. I can only provide you with his outpatient benefit maximum is. So we, because it is a supplemental policy dated to his primary insurance, we will also have to receive a copy of the primary insurance company's explanation of benefits along with the claim for review.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then uh once we have processed our claim.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] We do have a portal that you should be able to check claim status in and have access to our explanation of benefits and our website that you would go to for that is secured.
[AGENT][NEUTRAL] [PII]blic.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Hi, [PII]. Thank you for all your help. I just need a reference number for this, please.
[AGENT][NEUTRAL] Oh, you still
[AGENT][POSITIVE] Yes ma'am, you would use my name along with today's date, and is there anything else that I can help you with?
[CUSTOMER][POSITIVE] No, thank you. You have a nice weekend.
[AGENT][POSITIVE] Well, you too, and thank you again for calling APL. I hope you have a nice weekend as well.
[CUSTOMER][NEUTRAL] OK bye bye.
[AGENT][NEUTRAL] Yes, ma'am. Bye-bye