AccountId: 011433970860
ContactId: 74b7054b-878d-4c5a-a4d1-fd8b4d5f5ccb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 287700 ms
Total Talk Time (AGENT): 127188 ms
Total Talk Time (CUSTOMER): 96487 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/74b7054b-878d-4c5a-a4d1-fd8b4d5f5ccb_20250429T18:51_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from AI Physical Therapy to check on the benefits for the patient.
[AGENT][NEUTRAL] I'm so sorry, um, it's very difficult to hear you. Could you repeat that?
[CUSTOMER][NEUTRAL] So, hi, this is [PII] calling from ATR Physical Therapy to check on the benefits for the patient.
[AGENT][NEUTRAL] OK, we need to check physical therapy benefits.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and I'm sorry, what did you say your name was?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and then, uh, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure. I will provide you that. So it is going to be [PII]. And can I get spelling of your name if you don't mind?
[AGENT][NEUTRAL] Uh, that's gonna be [PII]
[AGENT][NEUTRAL] And then did you have that policy number?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Yeah, I do have it is 02576722.
[AGENT][NEUTRAL] OK and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Patient's name is [PII].
[CUSTOMER][NEUTRAL] [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. Uh, so this policy is active. Effective date was [PII], and this is a secondary medical policy, so it is designed to help with co-pay, deductible and co-insurance after major medical pays. If you'll give me one moment, I will see if uh physical therapy is a covered benefit under this policy.
[CUSTOMER][NEUTRAL] So it is
[CUSTOMER][NEUTRAL] OK. Sure.
[AGENT][NEUTRAL] OK, and of course I will let you know verification of coverage is not a guarantee of payment for claims, so physical therapy performed in a physical therapy facility is covered under their outpatient benefits. That outpatient benefit is on a per calendar day basis. It pays $500 max per calendar day.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] So it is an uh accident insurance?
[AGENT][NEUTRAL] No, this is a secondary medical policy.
[CUSTOMER][NEUTRAL] OK. I just need to know about the patient's uh policy type. It is APL, HMO PPO.
[AGENT][NEUTRAL] It's a secondary medical policy. It follows major medical guidelines. Again, that outpatient benefit pays on a per calendar day basis up to $500.
[AGENT][NEUTRAL] After major medical pays.
[CUSTOMER][NEUTRAL] And what about the group number?
[AGENT][NEUTRAL] Uh, group number?
[AGENT][NEUTRAL] I'm sorry, did you say you needed that group number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] That is 26142.
[CUSTOMER][NEUTRAL] Got it. Thank you. And it's a calendar your policy?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So all benefits will be applicable as within the Medicaid guidelines?
[AGENT][NEUTRAL] It follows major medical guidelines.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] It follows major medical guidelines.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] There is a PT benefits is covered, which is for $500 per visit, right?
[AGENT][NEUTRAL] Per calendar day is their outpatient benefit amount and that goes towards co-pay, deductible and co-insurance after major medical pays.
[CUSTOMER][NEUTRAL] How
[CUSTOMER][NEUTRAL] OK, per calendar day, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And then is the authorization and PCP referral is required?
[AGENT][NEUTRAL] No, no authorization is required as long as major medical is willing to pay this policy can.
[CUSTOMER][NEUTRAL] Got it. Thank you. And does the, uh, so you do, as you stated, is it we are secondary insurance, right?
[AGENT][NEUTRAL] This is a secondary medical policy, yes.
[CUSTOMER][NEUTRAL] Got it. Thank you. So that's all for today. Can I get the call reference number for this call?
[AGENT][NEUTRAL] Sure, reference number would just be my first name, last initial, and today's date and signing is spelled K A R A. Last initial is A. And was there anything else I could help you with?
[CUSTOMER][NEUTRAL] The
[CUSTOMER][POSITIVE] That's all for today. Thank you so much for assisting me today and have a wonderful day. Bye.
[AGENT][POSITIVE] All right. Yeah, thanks for calling APL. You too. Thank you. Bye-bye.