AccountId: 011433970860
ContactId: 5196d56f-c053-454c-9a82-a0c5320ae477
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 432450 ms
Total Talk Time (AGENT): 135266 ms
Total Talk Time (CUSTOMER): 145645 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/5196d56f-c053-454c-9a82-a0c5320ae477_20250610T15:03_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh hello [PII], this is [PII] from ATI Physical therapy. So I need to verify benefits for physical therapy.
[AGENT][NEUTRAL] I can help you with uh benefits, [PII]. Can I get where you're calling from one more time, please?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, from ATI physical therapy.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] And a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Um, [PII], no extension.
[AGENT][NEUTRAL] Could you please repeat that? It looks, it sounded like we were breaking up for a second.
[CUSTOMER][NEUTRAL] OK, no problem, just one moment.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Um, 02446530.
[AGENT][NEUTRAL] I have 02446530, correct?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Yes, ma'am. Yes ma'am.
[AGENT][NEUTRAL] Give me just one moment.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] And can I get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, sure, uh, [PII] and the date of birth it's uh [PII].
[AGENT][POSITIVE] OK, thank you so much give me just one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you wanted physical therapy benefits, correct?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, give me just one moment, I'm pulling that up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, and this is just a verification of benefits, not a guarantee of payment. It looks like they have an outpatient benefit maximum of up to $500 per calendar day.
[AGENT][NEUTRAL] The outpatient um services does include physical therapy and a physical therapy facility.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, with a maximum of 30 days of treatment per calendar year.
[CUSTOMER][NEUTRAL] Oh wait, is it like 30 visits for a calendar year or like 30 days, um, can you like elaborate a little bit more?
[AGENT][NEUTRAL] So 30 days of treatment. So if they, so 30, 30 times, they can see 30 times for physical therapy.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, got you.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] And is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Uh, one moment, uh, so is there any, um, a individual out of pocket or anything like that?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm sorry, is there any, any what?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah, I, I'll just walk it maximum.
[CUSTOMER][NEUTRAL] For individual.
[CUSTOMER][NEUTRAL] So there's no deductible, right?
[AGENT][NEUTRAL] Right, there's a $0 outpatient deductible, and they have the benefit maximum of up to $500 per calendar day.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] How much they have used?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEGATIVE] No, none of it has been used to date.
[CUSTOMER][NEUTRAL] OK, alright, got it. Uh, so we need sort of benefit maximum though, is it like the same thing as the out of pocket?
[CUSTOMER][NEUTRAL] Or is it something else?
[AGENT][NEUTRAL] So after the primary insurance um pays at least partial or partial, then you can file a claim through this policy and it will cover up to $500.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][POSITIVE] I got you.
[AGENT][NEUTRAL] Per per calendar day. Mhm.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, got it one second.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] So, uh, can I have the patient's policy name?
[AGENT][NEUTRAL] Um, it's a Medlink policy.
[CUSTOMER][NEUTRAL] Medli
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, is it a HMO or PPO? like what type of plan is that?
[AGENT][NEUTRAL] Uh, no, we don't participate in or out of network. This is just secondary gap.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] So I'm just gonna go
[CUSTOMER][NEUTRAL] Uh, so I have a question that even if the, uh, let's just say the patient, um, uh, uh, patient primary is like BCBS or something, uh, the insurance would still cover, cover, right, or is it only applicable if the primary is like Medicare or something?
[AGENT][NEUTRAL] The primary will need to cover um services first and then we can pick up the rest.
[CUSTOMER][NEUTRAL] No, I'm just asking like, even if it's like any commerce. I got you.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Um, can I have the effective date though?
[AGENT][NEUTRAL] The effective date for this policy is [PII].
[CUSTOMER][POSITIVE] Alright, thank you.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Um, so I, I, I believe we would not require authorization and referral, right?
[AGENT][NEUTRAL] Correct, you'll the, uh, but we can't speak for the primary. You'll have to call them.
[CUSTOMER][NEUTRAL] Yeah, I know, I know that, but I'm just asking for, for your insurance. OK, can I have your name please?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, we do not.
[AGENT][NEUTRAL] Um, my name is [PII].
[CUSTOMER][NEUTRAL] OK, uh, initial to your last name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, uh, can I please have a call reference number?
[AGENT][NEUTRAL] So we don't have call reference numbers but you can use my name and last initial in today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][POSITIVE] Alright thank you so much ma'am I appreciate it um you have a good day.
[AGENT][POSITIVE] You too thank you for calling APL.