AccountId: 011433970860
ContactId: 6f766b59-b271-4266-bc67-27da4fc727e4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 384480 ms
Total Talk Time (AGENT): 115540 ms
Total Talk Time (CUSTOMER): 333449 ms
Interruptions: 19
Overall Sentiment: AGENT=0.4, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/6f766b59-b271-4266-bc67-27da4fc727e4_20250609T14:54_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Good morning. This is [PII] from Emmanual Therapy Center Group. How are you doing?
[AGENT][NEUTRAL] I'm fine, and I'm sorry, your name is again?
[CUSTOMER][NEUTRAL] She was.
[CUSTOMER][NEUTRAL] [PII], can I have yours? Got it. Hi [PII], my name is [PII] and my last initial is [PII].
[AGENT][NEUTRAL] It's [PII], last [PII] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and Ms. [PII], how may I assist you today?
[CUSTOMER][NEUTRAL] So, so I'm calling in today to um see if the gap covers the patient for physical therapy.
[CUSTOMER][NEUTRAL] He has the insurance Cigna that his wife called to let me know that he has a gap, and then um she said that that should cover his full physical therapy treatment and we want to call in to see if that could be verified, if that could be checked to see if it will be covering or will her insurance have to cover, yeah. So the policy number, let me see if she gave me the policy number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, what's the policy number, please?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] She give me the group number. I'm not seeing. Let me see, uh, do do do do do do do do do. I have two numbers here. I have the group number and this one says the outpatient search number. I don't know if that might be the policy number.
[AGENT][NEUTRAL] Yes ma'am, what's the outpatient number?
[CUSTOMER][NEUTRAL] It's.
[CUSTOMER][NEUTRAL] OK, so it's 0204.
[CUSTOMER][NEUTRAL] 5296 M as in Mary, L as in Larry, and the number 8. Of course I do. Callback number direct line is [PII].
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Of course, patient's name is [PII]. Let me know if you spell it out for you.
[AGENT][NEUTRAL] OK, and the patient's name, date of birth?
[AGENT][NEUTRAL] No, you're fine. And the date of birth?
[CUSTOMER][NEUTRAL] Date of birth of the member or patient is uh [PII].
[AGENT][NEUTRAL] OK, give me one moment to pull up their information.
[CUSTOMER][NEUTRAL] OK, give me one moment OK. Correct, yes, physical therapy.
[AGENT][NEUTRAL] You said for physical therapy, correct?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, yes, physical therapy is covered under the policy as outpatient, uh, not a guarantee of payment, just a verification of coverage. With this policy is secondary, we pick up what primary applies towards deductible, co-pay, and or co-insurance, and the patient has a benefit max up to 6600 per calendar year.
[CUSTOMER][NEUTRAL] yes, physical therapy is covered under the policy. It's outpatient.
[CUSTOMER][NEUTRAL] Not a guarantee of payment, just verification of coverage with this policy as secondary, we pick up what primary.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so let me write that down again, [PII]. So it's not a guarantee. So, um, just to be sure, is he covered or does the insurance have to pay first in order for him to get the gap?
[AGENT][NEUTRAL] Well, this is a secondary policy, so the primary insurance has to process the claim first and what we do is secondary pick up what they apply towards deductible, co-pay or co-insurance up to that max benefit.
[CUSTOMER][NEUTRAL] OK, let me write that down. Secondary, secondary. Can you say one more time? [PII] secondary OK.
[AGENT][NEUTRAL] Uh, we're a secondary insurance.
[AGENT][NEUTRAL] And we pick up what primary applies towards deductible, co-pay, or co-insurance up to the benefit max.
[CUSTOMER][NEUTRAL] OK, primary, OK, so we pick up a primary.
[CUSTOMER][NEUTRAL] I'm, I'm just trying to write a word for her so I can tell the patient. OK, secondary insurance you guys pick up what primary covers you said?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Applies towards deductible, co-pay, or co-insurance.
[CUSTOMER][NEUTRAL] A copay or towards that towards.
[CUSTOMER][NEUTRAL] Deductible.
[CUSTOMER][NEUTRAL] Deductible and.
[AGENT][NEUTRAL] Deductible, co-pay, and co-insurance.
[CUSTOMER][NEUTRAL] Co-pay and co-insurance, OK, deductible copay and co-insurance, coinsurance. OK, so for sure her insurance has to cover it for like you said whatever they have pending, then you guys will pick it up, is that right?
[AGENT][NEUTRAL] Only those three. So if a max was, uh, any benefit was applied towards those three deductible, co-pay or co-insurance, that's what we pick up as secondary up to the max benefit.
[CUSTOMER][NEUTRAL] OK, up to the max or up to the max.
[CUSTOMER][NEUTRAL] Can you repeat that one more time, [PII]? I'm sorry I have people in the background here talking. It's kind of hard to make out.
[AGENT][NEUTRAL] I hear you. Uh, up to the max applied towards deductible, co-pay or co-insurance, up to the benefit max.
[CUSTOMER][NEUTRAL] Up to the max up to the benefit, OK, up.
[CUSTOMER][NEUTRAL] To the benefit.
[CUSTOMER][NEUTRAL] Fit Max. OK, hang on, er, meta pue cureur primer prime loqueoja.
[CUSTOMER][NEUTRAL] Manga.
[CUSTOMER][NEUTRAL] OK, OK, [PII], would you be so kind to provide me the reference number to this call so I can save it?
[AGENT][NEUTRAL] Uh, if you like, you may use my name in today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, which would be [PII] with your name. OK, got it.
[CUSTOMER][POSITIVE] Alright, [PII], thank you so much. If the member or patient has any other questions, they can give you guys a call, right?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Alright, thank you so much [PII] you have a great one.
[AGENT][POSITIVE] Oh, you too. Thank you for calling APL. Bye.
[CUSTOMER][NEUTRAL] Alright, bye.
[CUSTOMER][NEUTRAL] Yeah