AccountId: 011433970860
ContactId: 1aaab63a-1b02-465c-9723-28e29448b9fc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 542190 ms
Total Talk Time (AGENT): 165876 ms
Total Talk Time (CUSTOMER): 111447 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/1aaab63a-1b02-465c-9723-28e29448b9fc_20250428T15:01_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling from broad office. I need to check patient eligibility and benefits for physical therapy.
[AGENT][NEUTRAL] OK, I could check eligibility and benefits for you. Uh, [PII], can I get a good call back number from you first and.
[AGENT][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, [PII]. This is direct line.
[AGENT][NEUTRAL] OK, thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Yeah, the policy number was
[CUSTOMER][NEUTRAL] 023
[CUSTOMER][NEUTRAL] 481
[CUSTOMER][NEUTRAL] 17 M as in Mary, L as in Larry, 8.
[AGENT][NEUTRAL] OK and uh what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Uh my name was [PII].
[CUSTOMER][NEUTRAL] Date of birth is.
[CUSTOMER][NEUTRAL] Just a second.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Could you repeat that? I'm sorry.
[CUSTOMER][NEUTRAL] 521 [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. So this policy is active. Effective date was [PII], and this is a secondary medical policy, so it is designed to help with co-pay, deductible and co-insurance after major medical pays. And just give me one moment and I'll double check to see if uh physical therapy is a covered benefit under this policy.
[CUSTOMER][NEUTRAL] OK, sure.
[AGENT][NEUTRAL] OK. And of course, I will let you know verification of coverage is not a guarantee of payment for claims. So physical therapy performed in a physical therapy facility is going to be covered under their outpatient benefits. The outpatient benefit is $4000 max per calendar year. If you'll give me one moment, I'll see if any of that has been used.
[CUSTOMER][NEUTRAL] I did.
[AGENT][NEUTRAL] OK, so so far this year, uh, $710.15 of that benefit has been used.
[CUSTOMER][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] Sorry.
[CUSTOMER][POSITIVE] Yeah, thank you for holding. Sorry for the long hold.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] You are a secondary plan.
[AGENT][NEUTRAL] Yes, this is secondary medical.
[CUSTOMER][NEUTRAL] And patient has
[CUSTOMER][NEUTRAL] Coverage for physical therapy will be covered.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Could you repeat one second information of eligibility?
[AGENT][NEUTRAL] Um, I'm sorry, uh, you said repeat the eligibility?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yeah, it is currently active. Um, the effective date was [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And you uh as a calendar plan or plan airplane? This is.
[AGENT][NEUTRAL] It is calendar year.
[CUSTOMER][NEUTRAL] Calendar
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And go ahead for the.
[CUSTOMER][NEUTRAL] Eligible benefits.
[AGENT][NEUTRAL] Yes, so physical therapy performed in a physical therapy facility is going to be covered under their outpatient benefits, which is $4000 max per calendar year.
[CUSTOMER][NEUTRAL] 4000 maximum amount for calendar year.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEGATIVE] And nothing else used.
[AGENT][POSITIVE] Yes, she has used some of that so far this year.
[AGENT][NEUTRAL] That was she has used $710.15.
[CUSTOMER][NEUTRAL] OK, that's been used.
[CUSTOMER][NEUTRAL] And you will follow any medi uh primary guidelines or not?
[AGENT][NEUTRAL] It follows a major medical guidelines.
[CUSTOMER][NEUTRAL] OK. And patient for primary patient responsibility, you will go up to $4000 and patient has used among that $710. 15 cents.
[AGENT][NEUTRAL] Yes, $4000 is the total benefit amount that we would pay per calendar year, and she has used $710.15 so far.
[CUSTOMER][NEUTRAL] Once the 4000 has been met, yeah.
[CUSTOMER][NEUTRAL] OK. There is any limit based on uh physical therapy?
[AGENT][NEUTRAL] Could you repeat that?
[CUSTOMER][NEUTRAL] There is any visit limit based on physical therapy?
[AGENT][NEUTRAL] No, there's there, uh, physical therapy does not have a limit.
[AGENT][NEUTRAL] Just this to this calendar year maximum.
[CUSTOMER][NEUTRAL] OK. And could you provide me the claim any address and uh
[CUSTOMER][NEUTRAL] Be ready.
[AGENT][NEUTRAL] Yes, our mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that is in [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] OK, and payer ID.
[AGENT][NEUTRAL] That is 60801.
[CUSTOMER][NEUTRAL] 60801.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] And a group number?
[AGENT][POSITIVE] Uh, yes, let me get that for you.
[AGENT][NEUTRAL] The group number is 25,700.
[CUSTOMER][NEUTRAL] And by the way, I'll just spell your name.
[AGENT][NEUTRAL] Uh, my name is spelled [PII]
[AGENT][NEUTRAL] And was there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] OK, last initial?
[AGENT][NEUTRAL] A
[CUSTOMER][NEUTRAL] Could you call reference number?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date.
[CUSTOMER][POSITIVE] OK, thank you for the information. Have a wonderful day. Take care. Bye.
[AGENT][POSITIVE] Of course, thanks for calling APL. You too. Thank you. Bye-bye.