AccountId: 011433970860
ContactId: 36ca9544-27f7-4411-84a0-6f6f5e456de2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 183059 ms
Total Talk Time (AGENT): 83404 ms
Total Talk Time (CUSTOMER): 67054 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/36ca9544-27f7-4411-84a0-6f6f5e456de2_20250210T14:53_UTC.wav
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[AGENT][POSITIVE] And thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Yes, I'm calling to get benefits for a member for physical therapy, please.
[AGENT][NEUTRAL] Um, yes, ma'am. I can assist you with benefits. Um, first, could I get your name and a good callback number?
[CUSTOMER][NEUTRAL] Uh my name is [PII].
[CUSTOMER][NEUTRAL] And it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Extension [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII]. Now, could I get the policy number, please?
[CUSTOMER][NEUTRAL] It is 024.
[CUSTOMER][NEUTRAL] 738.
[CUSTOMER][NEUTRAL] 300, excuse me, I'm sorry, 02478300.
[AGENT][NEUTRAL] Mhm. And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] And just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII]. The policy is still active and for physical therapy, let's see.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] We cover up to $5000 per calendar year and that's for the co-pay, the co-insurance, and the deductible after the primary insurance processes the claim, but there is a $100 deductible that needs to be met first.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then after that deductible you guys cover up to 5000.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, hold on just a second.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You happen to have who's listed as um uh primary on their end? I've got Blue Cross Blue Shield, but I don't think that's right.
[AGENT][NEUTRAL] Um, no, ma'am. We actually don't know who the primary insurance is until we receive the claims from you guys, the providers. We don't keep that on file.
[CUSTOMER][NEUTRAL] Oh, got it.
[CUSTOMER][POSITIVE] Got you, got you.
[CUSTOMER][NEUTRAL] OK, and out of that $100 deductible, have they made anything yet?
[AGENT][NEUTRAL] Um, so far, she hasn't met anything this year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you guys don't have a visit limit or anything like that?
[AGENT][NEUTRAL] No, the only limit is the dollar amount.
[CUSTOMER][NEUTRAL] OK, no authorization?
[AGENT][NEUTRAL] That's correct, because we go by the primary carrier's guidelines.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Alright, that works for me if I could just have your name and reference number, that'd be it.
[AGENT][NEUTRAL] OK, for the reference number, you can use my name in today's date. My name is [PII], um it's spelled [PII] and my last initial is [PII] in today's date. Is there anything else that I can assist you with?
[CUSTOMER][POSITIVE] No ma'am, that's all thank you so much.
[AGENT][POSITIVE] OK, thank you, [PII] for calling ATL. You have a great day. Mm bye.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Mm, thank you.