AccountId: 011433970860
ContactId: 3a8abb99-9ea3-4e29-b271-08a81f7326fb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 340010 ms
Total Talk Time (AGENT): 134349 ms
Total Talk Time (CUSTOMER): 110849 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/3a8abb99-9ea3-4e29-b271-08a81f7326fb_20250212T15:36_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh hi [PII], this is [PII] from Vilanis Associates Comprehensive Therapy. Just wanted to ask for eligibility and benefits for [PII].
[AGENT][NEUTRAL] Yeah, I can check.
[AGENT][NEUTRAL] OK, yeah, I can check eligibility and benefit for you. You said your name was [PII]?
[CUSTOMER][NEUTRAL] Uh, [PII].
[AGENT][NEUTRAL] Right, OK, and can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[AGENT][NEUTRAL] OK, thank you. Do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, uh, it's 02473091, M as in Mike, L as in Lima, the number 8.
[AGENT][NEUTRAL] OK, thank you and what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Uh [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that, [PII]. 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 we were needing to check that outpatient benefits.
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] OK, of course I will let you know verification of coverage is not a guarantee of payment for claims, so their outpatient benefit is on a per calendar day basis. It pays up to $300 per calendar day.
[CUSTOMER][NEUTRAL] OK, so I just wanted to ask regarding with the benefit for this one for physical therapy in network in office setting.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Physical therapy, OK.
[AGENT][NEUTRAL] Give me just a moment, let me see if that is going to be a covered benefit.
[AGENT][NEUTRAL] But is it gonna be, I'm sorry, I know you said an office setting, is it an actual physical therapy facility?
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] It is OK alright one moment please.
[AGENT][NEGATIVE] Bear with me just a moment, it's running just a little slow.
[CUSTOMER][POSITIVE] That's OK, thank you.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so yes, uh, physical therapy performed in a physical therapy facility is going to be covered under their outpatient benefit.
[CUSTOMER][NEUTRAL] OK, this will be covered, right? Is there any limitation for this one?
[AGENT][NEUTRAL] Not for physical therapy. Again, it is.
[CUSTOMER][NEUTRAL] Like how many visit limit?
[AGENT][NEUTRAL] I'm sorry.
[CUSTOMER][NEUTRAL] Uh-huh, but
[AGENT][NEUTRAL] No, you're OK?
[CUSTOMER][NEUTRAL] Uh, how many visit limits?
[AGENT][NEUTRAL] What
[AGENT][NEGATIVE] This one is not uh does not have any limits for a year.
[CUSTOMER][NEUTRAL] OK, so this is somehow based on medical necessity, right?
[AGENT][NEUTRAL] It's a
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] And again, this plan is very dependent on the major medical so if they're not willing to pay this policy cannot.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, sure. No worries. Patient has uh primary insurance. And you said that there is like a limit for this one, like $300 is that correct?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's yes, their outpatient benefit. It does not have a yearly maximum it's per calendar day, a daily maximum of $300 that this benefit would pay.
[CUSTOMER][NEUTRAL] $300 per day, right? Not per year?
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] OK. OK, sure. Thank you very much. Just one moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Just a minute. Does this insurance also pick up the deductible of the primary or not?
[AGENT][POSITIVE] Yes, it is designed to help with co-pays, deductible, and then co-insurance.
[CUSTOMER][NEUTRAL] Is the patient has a uh deductible for the second diary and out of pocket or none?
[AGENT][NEGATIVE] No, not for this plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You know visiting.
[CUSTOMER][NEUTRAL] OK, perfect. Do you have a reference number for this call?
[AGENT][NEUTRAL] It would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII] Was there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] Uh, I'm sorry, [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] And today's day. Thank you very much and have a great day. Bye bye. Thank you.
[AGENT][POSITIVE] Of course, yeah, thanks for calling APL you too bye bye.
[CUSTOMER][NEUTRAL] By the way, I'm sorry, uh, is authorization required for this? I'm sorry.
[AGENT][NEUTRAL] Oh, yes.
[AGENT][NEUTRAL] No, no, no, no authorization is required. Again, it's as long as Major Medical is willing to pay this policy can.
[CUSTOMER][POSITIVE] Perfect. OK, thank you very much have a great day bye bye.
[AGENT][POSITIVE] Of course, yep, thanks [PII]. You too, bye bye.