AccountId: 011433970860
ContactId: 6fca67b7-810b-4be9-a08a-65a753f41925
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 228729 ms
Total Talk Time (AGENT): 121722 ms
Total Talk Time (CUSTOMER): 99022 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/6fca67b7-810b-4be9-a08a-65a753f41925_20250320T15:59_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thank you for calling APR. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, excuse me, my name is [PII]. I'm calling from the provider's office. I'm trying to check eligibility and benefits for our patients.
[AGENT][NEUTRAL] I'm sure, [PII], I can assist you with benefits. Um, first, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] OK, thank you. Now, could I get the policy number, please?
[CUSTOMER][NEUTRAL] 02517379.
[AGENT][NEUTRAL] Thank you. Now, please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII], uh, date of birth is [PII].
[AGENT][NEUTRAL] Thank you and just let me advise you that verification of coverage does not guarantee payment of claim. Um, the effective date on this policy was [PII] and the policy is still active. Um, is this for inpatient or outpatient benefits or an office visit?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, it's gonna be for physical therapy done in the office. We build professional outpatient physical therapy done in the office.
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] OK. Yes, ma'am. And for physical therapy, that'll be covered under the outpatient benefit. And for outpatient, we cover up to $4800 per calendar year and that's for the co-pay, the co-insurance, and the deductible after the primary insurance processes the claim, but there is a $100. Mhm.
[CUSTOMER][NEUTRAL] So she
[CUSTOMER][NEUTRAL] I'm sorry, I don't mean to cut you off. I just wanna make sure I have this right, so this is like a secondary insurance she should have a primary. I think this is all she gave us.
[AGENT][NEUTRAL] Yes, ma'am. She should have a primary. This is secondary coverage.
[CUSTOMER][NEUTRAL] OK, so they pay up to 4800 per year, OK?
[AGENT][NEUTRAL] Right. And there's a $100 deductible that needs to be met first.
[CUSTOMER][NEUTRAL] OK, and nothing's met on the deductible yet, OK, and what was your name again?
[AGENT][NEUTRAL] Um, it's [PII]. Um, it's spelled [PII] and my last initial is [PII]. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] Oh, do I need any authorization or pre-cert or anything on this plan?
[AGENT][NEUTRAL] Um, no, ma'am. Since it's secondary, we go by the primary insurance guidelines, so there's no authorization required with us.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, and then the $4800 is that for like all outpatient services?
[AGENT][NEUTRAL] Yes, it is. Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, do you know if she's used any of that?
[AGENT][NEUTRAL] Um, no, she hasn't used any of it this year.
[CUSTOMER][NEUTRAL] OK, and then um do they have like an out of pocket or anything or after the deductible and after the primary pays and it picks up 100% or?
[AGENT][NEUTRAL] Right after um the primary insurance covers it, what goes for the co-pay, the co-insurance and deductible, we cover that, um.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Up to 100% until she meets her benefit maximum which is $4800 per calendar year, but she has to meet that $100 deductible first, which she haven't met yet. Mhm.
[CUSTOMER][NEUTRAL] First with y'all, OK.
[CUSTOMER][NEUTRAL] OK and then does this run like on a calendar year?
[AGENT][NEUTRAL] Yes, ma'am, it's calendar year.
[CUSTOMER][NEUTRAL] OK, alright, I think I have everything I need um, can I just get a reference number for the call?
[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. Um, is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No ma'am, thank you so much I appreciate it.
[AGENT][POSITIVE] OK, [PII] thank you, [PII], for calling ATL. You have a great day. Mm bye.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh huh you also.