AccountId: 011433970860
ContactId: 32b3efaa-8a96-471c-9795-dee638ce5465
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 501140 ms
Total Talk Time (AGENT): 191549 ms
Total Talk Time (CUSTOMER): 211398 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/32b3efaa-8a96-471c-9795-dee638ce5465_20250421T16:21_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Uh hello, my name is [PII]. Uh, I'm calling on behalf of ATI Physical therapy. Um, so I wanted to check benefits, uh, for the member that I have, so, uh, I need to get the physical therapy benefits for the member that I have.
[AGENT][NEUTRAL] OK, sure. I can assist you with physical therapy benefits. And may I have the name of the facility one more time?
[CUSTOMER][NEUTRAL] Um, API physical therapy.
[AGENT][NEUTRAL] OK, thank you. And may I have a callback number just in case we get disconnected, Mr. [PII]?
[CUSTOMER][NEUTRAL] Um, sure, so that that would be [PII] and then [PII].
[AGENT][NEUTRAL] And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] I'm sure you can just one moment.
[CUSTOMER][NEUTRAL] So I have 024 and then 985 and then 70.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Ah
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] OK, so I have.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] One moment. [PII], uh the date of birth is [PII]. Yo, can you hold on for a second, just one moment.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] This one
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Hello. Thank you so much for your patience. Uh, all right, so what do you need now?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I need his date of birth.
[AGENT][NEUTRAL] Mr. [PII].
[CUSTOMER][NEUTRAL] Alright, so the date of birth is [PII].
[AGENT][NEUTRAL] OK. And what's the date of service, or you, you say you need benefits. Bear with me just a second. Let me pull benefits, OK?
[CUSTOMER][NEUTRAL] Uh, yeah, general benefits, yeah, alright.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Before I give you any benefit informa.
[CUSTOMER][NEUTRAL] Uh, so before we, uh, yeah, yeah, go ahead.
[AGENT][NEUTRAL] Yes, go ahead.
[CUSTOMER][NEUTRAL] Alright, so I just wanted to know like uh are you like secondary insurance?
[AGENT][NEUTRAL] We are.
[CUSTOMER][NEUTRAL] OK uh alright got you uh this is not a Medicare supplement it is just a regular secondary insurance, right?
[AGENT][NEUTRAL] No. This is a secondary to the major medical.
[CUSTOMER][NEUTRAL] OK, got you, OK.
[AGENT][NEUTRAL] OK. All right. So, before I give you any benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright
[AGENT][NEUTRAL] OK, for the outpatient benefits, it looks like um there is the combined benefit of 200, um, I do apologize, it's 1000, it's not combined. Outpatient benefit is 1000 per covered person per occurrence. So it's 1000 per cover person per occurrence, and this includes physical therapy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] Aye.
[CUSTOMER][NEUTRAL] So the $1000 is it, is it a deductible or is it out of pocket? Like what is it though?
[AGENT][NEUTRAL] OK, that $1000 is the maximum benefit. So that will be the maximum benefit allowed for the policy. Now, it is um per occurrence, meaning that if it's related to the same treatment or condition, it needs to be separated by 90 days. OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I'm sorry, I'm saying one more time, one more time, your, your line got cut out. So what does occurrence mean? Like what was it?
[AGENT][NEUTRAL] Her occurrence means it needs to be separated by 90 consecutive days if it's related to the same treatment or condition.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh-huh, uh-huh. OK, OK, OK, OK, OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right, just one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, can I have the patient's policy name?
[AGENT][NEUTRAL] This is a secondary supplemental plan to the major medical. The name of the product is Metlink.
[CUSTOMER][NEUTRAL] Oh, this is, uh, hold on, hold on, this is a supplemental policy.
[AGENT][NEUTRAL] This is a secondary supplemental plan to the major medical.
[CUSTOMER][POSITIVE] Yeah, yeah, OK, supplemental alright I got you.
[AGENT][POSITIVE] It's set up to help, yeah. Mhm.
[CUSTOMER][NEUTRAL] Yeah, yeah, no problem, uh, one second.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, um, can I, um, have the call reference number?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Alright, I got you. One second, so we do not require authorization and referral, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm sorry, can you repeat?
[CUSTOMER][NEUTRAL] Uh, so I'm just asking like, uh, uh, do we need to obtain a pre-certification like authorization for physical therapy?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No, we're just a secondary.
[CUSTOMER][NEUTRAL] OK, no, also no referral, right?
[AGENT][NEUTRAL] No, it, it has to be approved by the major medical.
[CUSTOMER][NEUTRAL] OK, got you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Um, OK, so, uh.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, so what, what is the patient's name, policy name?
[CUSTOMER][NEUTRAL] Do we have a name? I know it's American Public Life, but is there any, uh-huh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Are you talking about the product name or is it the um
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] The product name is Metlink.
[CUSTOMER][NEUTRAL] Uh, Medlink
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One second.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, is it a PPO plan or HMO plan or like what is it?
[AGENT][NEUTRAL] Is that a PP or a nation? It's commercial.
[CUSTOMER][NEUTRAL] I know I'm just asking like what type of plan is it? Do we have type?
[AGENT][NEUTRAL] It's, it's not a no, no. It's just a secondary supplemental plan to the major medical. It's not a PPO or an HMO.
[CUSTOMER][NEUTRAL] OK, got you.
[AGENT][NEUTRAL] Mhm. Yeah. It's not a major medical, so it doesn't have a work.
[CUSTOMER][NEUTRAL] Uh, and as the patient, can I have the effective rate? Can I have the effective date of the policy?
[AGENT][NEUTRAL] Yes, um, yes, the effective date is [PII], and it is active at the moment.
[CUSTOMER][NEUTRAL] Uh, OK, that's a member plan runs on calendar year or or a policy year.
[AGENT][NEUTRAL] Calendar year.
[CUSTOMER][NEUTRAL] Like when does the benefit, OK.
[CUSTOMER][POSITIVE] Alright, sure, no problem.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, so there's no, uh, visit limit or anything, right? Just $1000.
[AGENT][NEUTRAL] We follow primary.
[CUSTOMER][POSITIVE] Benefits for current.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Got you. And, and your name, can you spell your name?
[AGENT][NEUTRAL] Sure, that's [PII]. Last initial [PII].
[CUSTOMER][NEUTRAL] OK, and then, OK, uh, so.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, the [PII] is the last initial, the last name initial. So the first name is just [PII].
[CUSTOMER][POSITIVE] OK, OK. So, yeah. All right, right, got it. Uh, thank you so much, ma'am. I appreciate it. Uh, you have a, a great rest of your day.
[AGENT][POSITIVE] Thank you. You as well thank you for calling APL Mr. [PII]. Bye-bye.