AccountId: 011433970860
ContactId: 630c9438-51e6-452a-a740-ee9a58e5459e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 213809 ms
Total Talk Time (AGENT): 83011 ms
Total Talk Time (CUSTOMER): 64170 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/630c9438-51e6-452a-a740-ee9a58e5459e_20250203T18:08_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, yes, I was just calling, um, just to verify to see um what the coverage is for outpatient physical and occupational therapy services.
[AGENT][NEUTRAL] OK, yeah, let's take a look. Do you have the patient's policy number?
[CUSTOMER][NEUTRAL] I do, yes, it is 02456496.
[AGENT][POSITIVE] All right, thank you so much. Let me pull this up here.
[AGENT][NEUTRAL] And if I could get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] All right, thank you so much. So patient plan is active. The effective date on this is [PII] or the secondary insurance, so it'll cover deductible, co-pay, co-insurance. The primary does not. I'll double check and make sure that physical therapy is covered here. One second.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. So it looks like physical therapy is covered in an office or clinic with a physical therapist. Their outpatient benefit amount on this plan is a calendar day, which is $500 max.
[CUSTOMER][NEUTRAL] So they'll cover up to $500 per day.
[AGENT][NEUTRAL] Per day. Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that's just like you said whatever um the primary doesn't cover once they've once they've used it once, once they've applied what they have that just cover you guys cover the rest is that up to 500.
[AGENT][NEUTRAL] Right, exactly, yeah, the difference between, yeah, the primary, yeah, exactly.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK, is that for OT as well or is that just PT only?
[AGENT][NEUTRAL] No, yeah, it looks like for that as well.
[CUSTOMER][NEUTRAL] OK, is it 500 total for PT and OT, or do they each get their own 500?
[AGENT][NEUTRAL] Yeah, it's just that set amount of 500 for the calendar days so it doesn't matter what it's for, it'd be for both.
[CUSTOMER][NEUTRAL] OK, got you.
[AGENT][NEUTRAL] Is there anything else?
[CUSTOMER][NEUTRAL] Do you like, is there, is there like is there would would precert be required or anything like that? or is there like a limit?
[AGENT][NEUTRAL] Nope.
[AGENT][NEUTRAL] Uh, there's no pre-certification or authorization required from us, no.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect. All right, that should be everything and I'm sorry, what was your name?
[AGENT][NEUTRAL] My name is [PII], that's [PII]
[CUSTOMER][NEUTRAL] Is there a call reference?
[AGENT][NEUTRAL] Uh, that's gonna be my name with my last initial in today's date. The last initials my name is [PII].
[CUSTOMER][POSITIVE] All right, thank you so much.
[AGENT][POSITIVE] You're welcome. Have a good one.
[CUSTOMER][POSITIVE] Alright thank you you too bye bye.
[AGENT][NEUTRAL] Bye bye.