AccountId: 011433970860
ContactId: 5e37ab6a-f200-47cc-90f2-0106a5ad3efa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 214949 ms
Total Talk Time (AGENT): 103900 ms
Total Talk Time (CUSTOMER): 62993 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/5e37ab6a-f200-47cc-90f2-0106a5ad3efa_20250225T14:25_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APR. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I need to check benefits for a patient for hospital outpatient physical the I mean occupational therapy.
[AGENT][POSITIVE] Um, yes, ma'am. I can assist you with benefits. Um, first, I'll need your name and a good callback number.
[CUSTOMER][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] [PII] sorry.
[AGENT][NEUTRAL] Thank you, [PII]. Now, I need the policy number.
[CUSTOMER][NEUTRAL] Policy number 1 2nd.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Uh, it's 2 numbers on there. One says outpatient, one's in hospital.
[AGENT][NEUTRAL] I'll need the one for outpatient.
[CUSTOMER][NEUTRAL] 02571931 M as in Mary, L as in Larry 8.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Um, current, uh, group date of birth is [PII].
[AGENT][NEUTRAL] Thank you and just let me advise you that verification of coverage does not guarantee payment of claims. Um, I'm showing the effective date on this policy was [PII]. The policy is still active and let's see.
[AGENT][NEUTRAL] For occupational therapy, there's no coverage under this policy.
[CUSTOMER][NEUTRAL] No coverage?
[AGENT][NEUTRAL] Right, for occupational therapy.
[CUSTOMER][NEUTRAL] Is it do they have for physical therapy? No?
[AGENT][NEUTRAL] Yes, physical therapy is covered but not occupational therapy.
[AGENT][NEUTRAL] And for physical therapy, that's covered at
[AGENT][NEUTRAL] 2500 per calendar year for the co-pay, the co-insurance and deductible after the primary insurance.
[CUSTOMER][NEUTRAL] But one question, the codes are the same. It's just the, the eval code is different, so how would you know?
[AGENT][NEUTRAL] We would know um by the modifiers.
[AGENT][NEUTRAL] So if you submit a claim and it shows up under um occupational therapy, the gel modifier, that's not covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, what about, uh, DME?
[AGENT][NEUTRAL] Um, damning
[CUSTOMER][POSITIVE] Doable medical equipment mhm.
[AGENT][NEUTRAL] Yes, ma'am. One moment. Yes, DME is covered.
[CUSTOMER][NEUTRAL] I have the code that you need.
[AGENT][NEUTRAL] DME is covered, um, only the disposable. DME is not covered, but other DME codes are covered and that's covered up to 2500 per calendar year.
[AGENT][NEUTRAL] And if you would like for me to check the code, I can look it up for you.
[CUSTOMER][NEUTRAL] Yes, I have the code is L as in Larry 3933.
[AGENT][NEUTRAL] Yes, ma'am. That looks to be covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And is there anything else that I can assist you with?
[CUSTOMER][NEGATIVE] No thank you, um.
[CUSTOMER][NEUTRAL] Is there a reference number?
[AGENT][NEUTRAL] Yes, for the reference number, you can use my name and today's date. My name is [PII], um it's spelled [PII] My last initial is [PII] and today's date.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] OK, thank you, [PII] for calling ATL. You have a great day. Mm bye.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you.