AccountId: 011433970860
ContactId: 51c66be1-0c09-4a14-b9ff-2bab4a1f142b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 377299 ms
Total Talk Time (AGENT): 171236 ms
Total Talk Time (CUSTOMER): 160474 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/51c66be1-0c09-4a14-b9ff-2bab4a1f142b_20250507T22:40_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII] and I'm a Texas physical therapy specialist. How are you doing today?
[AGENT][POSITIVE] I am doing well, Ms. [PII]. How are you doing today?
[CUSTOMER][POSITIVE] I'm doing pretty good thank you for asking um I was calling to verify benefits for our patients. um I do have the policy number and I have his name and his date of birth.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. All right, Ms. [PII], I can help you with the benefits. Will you please give me your callback number, ma'am, just in case the calls dropped, I can call you right back.
[CUSTOMER][NEUTRAL] Yeah for sure it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And then what is the patient's name, date of birth, and policy number that you have?
[CUSTOMER][NEUTRAL] OK, so the policy number is 262.
[CUSTOMER][NEUTRAL] 252-3.
[CUSTOMER][NEUTRAL] And his name is [PII].
[CUSTOMER][NEUTRAL] And his date of birth is [PII].
[AGENT][NEUTRAL] OK, let me look up that policy real quick.
[CUSTOMER][NEUTRAL] OK, and I don't know if you um need the codes that we use to bill but I have those available if you need them.
[AGENT][NEUTRAL] No ma'am, I will not need those um.
[AGENT][NEUTRAL] Let me look at his benefits for you. Uh, first, let me give you his effective date. The policy is active and his effective date is [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And this is just to verify his benefits. It's not a guarantee of payment. I'm looking to see um if he has physical therapy benefits. Is that what he's coming for his physical therapy?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] In a physician setting.
[CUSTOMER][POSITIVE] That is correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, let me see.
[AGENT][NEUTRAL] He does have um outpatient accident and sickness treatment in a physician's office.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] He, in a, I'm sorry, in a
[AGENT][NEUTRAL] Good grief in a physical therapy office, outpatient accident and sickness treatment. He gets 4 visits a year.
[AGENT][NEUTRAL] And they pay $30 each.
[CUSTOMER][NEUTRAL] OK, so he gets um 4 visits.
[AGENT][NEUTRAL] Yes ma'am, this is a limited hospital indemnity plan.
[CUSTOMER][NEUTRAL] You said?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] So it has limited benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so like it's a total 4 per year?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] And then um he has a copay of $30.
[AGENT][NEUTRAL] No, ma'am. The, no, ma'am. The policy pays $30.
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] It's a flat rate that it pays, yeah.
[CUSTOMER][NEUTRAL] Oh, the policy, so he doesn't.
[CUSTOMER][NEUTRAL] Oh, so he doesn't pay anything, he's covered.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] In office.
[AGENT][NEUTRAL] Right, up to $30.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh, so he's covered up to $30 in office?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And then afterwards he'll get bills.
[CUSTOMER][NEUTRAL] Basically.
[AGENT][NEUTRAL] We don't, we don't do patient responsibility or bill them ourselves so that would be left up to the facility.
[AGENT][NEUTRAL] Um, to, to do that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, got you.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] All right, does he have it um.
[CUSTOMER][NEUTRAL] A deductible or in um out of pocket?
[AGENT][NEUTRAL] No ma'am, I do not see any deductibles or out of pocket that he needs to pay.
[CUSTOMER][NEUTRAL] OK. Is there a modality limit per day visit?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So it's just, um, it's a hospital indemnity plan is, is different in the fact that it pays a set amount for covered procedure. So for, in this instance, it's going to be the office um physical therapy treatment.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the covered amount is the $30. So even if you charge $10 we'll still pay $30 but if you charge $60 we're only going to pay $30.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] Does that explain it a little better?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, it, I mean, I understood what you um meant by that the insurance only covers up to $30 and um basically everything else would be the patient responsibility.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And it's just a basic plan basically OK.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] All right, well, do you have a reference number for this call?
[AGENT][NEUTRAL] Yes, ma'am. You can use my name, [PII], and today's date.
[CUSTOMER][NEUTRAL] Alrighty then and that's [PII]?
[AGENT][NEUTRAL] It's with a Y.
[CUSTOMER][NEUTRAL] With a [PII]? OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Alrighty then.
[CUSTOMER][POSITIVE] I appreciate that thank you so much.
[AGENT][POSITIVE] You're very welcome, Ms. [PII]. Is that everything I can help you with before we go?
[CUSTOMER][POSITIVE] Yes, that is, thank you.
[AGENT][POSITIVE] OK, well you have a wonderful night and thank you for calling APL.
[CUSTOMER][NEUTRAL] You too.
[CUSTOMER][POSITIVE] Thank you so much you do the same thank you bye bye.
[AGENT][NEUTRAL] Bye-bye, ma'am.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Uh huh bye bye bye.