AccountId: 011433970860
ContactId: 1b84af12-336b-42f3-a875-8dceb109df7b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 321359 ms
Total Talk Time (AGENT): 164611 ms
Total Talk Time (CUSTOMER): 72214 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/1b84af12-336b-42f3-a875-8dceb109df7b_20250507T20:37_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. I'm calling to find out for sure that my insurance will cover physical therapy before I schedule.
[AGENT][NEUTRAL] OK, um, I can check and see if you have benefits for physical therapy. Um, may I have your name and a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure, it's [PII], and my phone number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the policy number?
[CUSTOMER][NEUTRAL] The policy number I'm going to always with that policy number.
[CUSTOMER][NEUTRAL] 0, 2593894.
[AGENT][NEUTRAL] Thank you. And may I have your date of birth, mailing address and email address for verification, Miss [PII]?
[CUSTOMER][NEUTRAL] [PII] and then the address is [PII].
[AGENT][NEUTRAL] OK, what's your email address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] All right. And I see you have a secondary supplemental plan to the major medical. Um, let me go ahead and pull your benefits. Um, it needs to be approved in, um, paid by your major medical, OK, because we follow them and let me see if we cover that um part of the deductible co-payment or co-insurance. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm still waiting on the documents. One moment.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] I'm so sorry it's taking a little bit to pull up.
[AGENT][POSITIVE] All right, I think I got it.
[AGENT][NEUTRAL] And this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer.
[AGENT][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Yeah, I have a schedule, yeah, so I just wanna make sure that that's OK.
[AGENT][NEUTRAL] OK, so you have an outpatient of $500 per day, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me look at the breakdown of benefits, OK.
[AGENT][NEUTRAL] You give me a.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Physical therapy. Yes, and um yes, you do have the physical therapy benefit and that's part of your outpatient maximum.
[CUSTOMER][NEUTRAL] So I can go to any or they have to accept your insurance?
[AGENT][NEUTRAL] They need to take your primary insurance. We, we follow primary. So you need to be in network with your primary insurance. Your primary insurance needs to approve and apply the amount towards the deductible co-pay and co-insurance for us to cover.
[CUSTOMER][NEUTRAL] On
[CUSTOMER][NEUTRAL] Mm, so I go there, I pay and then ask reimbursement to you guys? How does that work?
[AGENT][NEUTRAL] OK. If it's approved by your major medical and they apply this amount towards the deductible co-payment and co-insurance, what you can do is go ahead and present the card at the time of service. So you will present both of your cards, your primary and this one as your secondary insurance.
[AGENT][NEUTRAL] And they can file the claim. If they don't have a system where they can take a secondary policy, then you can go ahead and request for an itemized bill before you leave. The itemized bill needs to have diagnosis code and you can submit your own claims once you receive the copy of the explanation of benefits from your primary insurance.
[CUSTOMER][NEUTRAL] And if so, you guys will cover 100%.
[AGENT][NEUTRAL] We cover the amount that is applied towards the deductible co-payment and co-insurance. So just an example, if you take physical therapy and the physical therapy visit or manipulation is um like 150 and they apply that to the deductible because you have a high deductible, then we'll pay the 150.
[CUSTOMER][POSITIVE] OK. All right, perfect. I will do that. Thank you so much. Appreciate it.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] You're welcome. Is there anything else I may help you with today?
[CUSTOMER][POSITIVE] That's all. Thank you.
[AGENT][POSITIVE] You're welcome and thank you for calling ATL. Have a good afternoon. Bye-bye.
[CUSTOMER][NEUTRAL] You too. Bye-bye.