AccountId: 011433970860
ContactId: 37b5ce41-e5bd-4174-a7cd-ad8a7f8ce87d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 295149 ms
Total Talk Time (AGENT): 118920 ms
Total Talk Time (CUSTOMER): 121980 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/37b5ce41-e5bd-4174-a7cd-ad8a7f8ce87d_20250509T21:28_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm calling on behalf of a facility to verify the um the eligibility and benefits for a patient that's being seen here for physical therapy.
[AGENT][POSITIVE] OK, well, I can definitely help you with the eligibility and benefits for physical therapy. May I have your name and a contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Of course my name is [PII] and then the phone number is gonna be [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Of course. Sorry, so I see here. Let me see. Oh, it's gonna read, um, having a little trouble reading it. Do you mind if I provide you the full name and the date of birth?
[AGENT][NEUTRAL] Um, yes, I can start with the name.
[CUSTOMER][NEUTRAL] Oh yeah, of course. So it's gonna be [PII], last name [PII] Date of birth is going to be [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] No
[AGENT][NEUTRAL] And you said the first name [PII]?
[CUSTOMER][NEUTRAL] Yeah, [PII], yeah, [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] I think this may be her. I'm gonna pull it up and see if it's the same date of birth. Does she have a middle initial? Because there's several [PII].
[CUSTOMER][NEUTRAL] she
[CUSTOMER][POSITIVE] Let me, you don't worry.
[CUSTOMER][NEUTRAL] Uh, no, um, is there anything I can provide you with like uh address or?
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Um, let me see if this is her first. Hold on one second.
[CUSTOMER][POSITIVE] Of course, no worries.
[AGENT][NEUTRAL] OK, yes, it's the same date of birth. OK. Well, thank you for verifying and all the information provided is a verification of benefits, not a guarantee of payment. So the policy number is 260.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Of course.
[AGENT][NEUTRAL] 69.
[CUSTOMER][NEUTRAL] 260.
[AGENT][NEUTRAL] Mhm. 6945.
[CUSTOMER][POSITIVE] Perfect, got you.
[AGENT][NEUTRAL] And the policy has been active since [PII]?
[CUSTOMER][NEUTRAL] Alright, perfect. OK, um, so do I have, uh, can I provide you with some CPT codes in place of service? We just wanna verify if they're if they're, if this will also because they presented this their card as a supplemental.
[AGENT][NEUTRAL] Right, this is secondary, but we don't really use the procedure code. It's more of, um, it's really just broken down into inpatient and outpatient. Are you, so you would be considered outpatient?
[CUSTOMER][NEUTRAL] Oh, OK, yeah.
[CUSTOMER][NEUTRAL] Yes, correct, we're a doctor's hospital outpatient hospital, yeah.
[AGENT][NEUTRAL] You said physical therapy, right?
[AGENT][NEUTRAL] OK. So the policy will pay up to $8700 per calendar year.
[CUSTOMER][NEUTRAL] Got you, 8700, uh huh mhm.
[AGENT][NEUTRAL] Let me
[AGENT][NEUTRAL] Look at this. Hold on one moment.
[AGENT][NEUTRAL] OK, and that does include um physical therapy and a physical therapy facility, but she also has the office treatment rider. So any treatment that's done in the office setting as long as it's not cosmetic, could be covered up to the 8700 per year.
[CUSTOMER][POSITIVE] OK perfect so she qualified with us, in other words.
[AGENT][NEUTRAL] Right, um, because whether, once we get the code, whether it comes back as a physical therapy facility or in office, she does have coverage for both. Um, of course, we can't guarantee anything for sure until we process it, but yes.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, perfect. Just wanted to go and verify that because patient, the patients here and just wanted to know. Alrighty then, OK, I think that is all I needed for today. Um, do you mind if I have a reference number just in case I have to call back with any other questions?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date, and again that's [PII] initial to my last name is [PII].
[CUSTOMER][POSITIVE] OK, and today's day got you alright perfect thank you so much for your assistance, OK?
[AGENT][POSITIVE] You're welcome, [PII]. Thanks for calling APL. I hope you have a great weekend.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you, bye bye.