AccountId: 011433970860
ContactId: 8ec939e8-2af7-4a2c-9942-9a5093e2b120
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 767869 ms
Total Talk Time (AGENT): 253484 ms
Total Talk Time (CUSTOMER): 254151 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/8ec939e8-2af7-4a2c-9942-9a5093e2b120_20250320T17:00_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling AL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from doctor's office to check on eligibility and benefits for the physical therapy. Could you please help me on that?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, yes, [PII], I can help you with eligibility and benefits. Can I please get your callback number and the name of the facility you're calling?
[CUSTOMER][POSITIVE] Yeah, I can help you with eligibility.
[CUSTOMER][NEUTRAL] Sure. My callback number is [PII]. It's direct line, no extension, and the facility name is Proactive Physical Therapy.
[AGENT][NEUTRAL] OK and then what is the patient's name, date of birth and birth?
[CUSTOMER][NEUTRAL] Yeah, patient name is uh.
[CUSTOMER][NEUTRAL] GNA and last name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, and the patient's policy number, please?
[CUSTOMER][NEUTRAL] Yeah, it's 02573210.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. I do show that uh
[AGENT][NEUTRAL] [PII] does have a [PII] does have an active policy and her active date is January.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And this is just to verify her benefits. It's not a guarantee of payment. This is a supplemental insurance policy. It's billed secondary to the primary. It's a gap insurance that helps with deduct copay and co-insurance.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] She has an inpatient benefit amount per calendar year of $5000 and then she also has an outpatient calendar year benefit amount.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, oh, no, just.
[AGENT][NEUTRAL] Of $1000.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is this like any medical supplement plan?
[AGENT][NEUTRAL] No, it's not associated with Medicaid.
[AGENT][NEUTRAL] It's billed secondary to her primary insurance.
[CUSTOMER][NEUTRAL] Not
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, so, not Medicare supplement plan, right?
[AGENT][NEUTRAL] Well, I mean, it's whoever major medical.
[AGENT][NEUTRAL] Insurances they bill first and we, we come in 2nd.
[CUSTOMER][POSITIVE] OK. Thank you so much. May I know the plant type?
[AGENT][NEUTRAL] It's Medlik.
[CUSTOMER][NEUTRAL] OK. Is it like any PPO or HMO?
[AGENT][NEUTRAL] No, it's, it's not anything like that.
[CUSTOMER][NEUTRAL] OK. Is there any group number?
[AGENT][NEUTRAL] Yes, ma'am, let me give that to you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] It is 19874.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's it, right?
[AGENT][NEUTRAL] I'm sorry, what did you just say? Can you repeat that?
[CUSTOMER][NEUTRAL] That's it, right? 19874.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK, thank you so much. Uh, just for the confirmation plan cost 100% without any patient responsibility, you follow the primary guidelines, right?
[AGENT][NEUTRAL] No, that's not what I said.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK. Could you please provide me the benefits of physical therapy? Is there any deductible or is there any co-pay or co-insurance or out of pocket?
[AGENT][NEUTRAL] OK, let me pull up the policy.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And let you know if they have physical therapy benefits.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] It's gonna be just a moment while I pull in the policy and read it.
[CUSTOMER][NEUTRAL] Oh, OK, OK.
[AGENT][POSITIVE] Thank you, ma'am.
[AGENT][NEUTRAL] OK, she does have physical therapy benefits and a.
[AGENT][NEUTRAL] Physical therapy facility.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Uh hello. Uh uh sorry, your voice is getting in and out. Could you please repeat again?
[AGENT][POSITIVE] Yes, she does have benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] How do you, does have the physical death benefits, right?
[AGENT][NEUTRAL] I'm sorry, what did, can you repeat that?
[CUSTOMER][NEUTRAL] She does have the physical therapy benefits, right? Are you saying?
[AGENT][NEUTRAL] Yes, it's covered for patient.
[CUSTOMER][NEUTRAL] OK. May I know the benefits whether the patient has any co-pay or coinsurance like that?
[AGENT][NEUTRAL] So the outpatient benefit per calendar year is $1000 to help with deductible, co-pay, or co-insurance.
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK. OK. This $1000 is uh out of pocket max, right?
[CUSTOMER][NEUTRAL] I see.
[AGENT][POSITIVE] No, that's the benefit. That's what she gets her, that's her out.
[CUSTOMER][NEUTRAL] So no deductible, right, for this patient?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] No deductible, no co-pay, no co-insurance, and no out of pocket, right?
[AGENT][POSITIVE] Correct, this policy helps with deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK. And could you please verify, is there any visit limit for this physical therapy?
[AGENT][NEUTRAL] No, once she reaches that $1000 her benefits will exhaust.
[CUSTOMER][NEUTRAL] OK, so patient first need to make the $1000 right?
[AGENT][NEGATIVE] No, no, no, no, no, no.
[AGENT][POSITIVE] That's the benefit, that's what we pay.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] First, you pay $1000 right?
[AGENT][NEUTRAL] The benefit of per calendar year is $1000.
[CUSTOMER][NEGATIVE] Oh sorry.
[CUSTOMER][NEUTRAL] OK. And what about the authorization, whether the authorization is required or not?
[AGENT][NEUTRAL] There's no authorization needed because this is not the primary insurance.
[CUSTOMER][NEUTRAL] OK. And what about the referral, whether the referral is required or not?
[AGENT][NEUTRAL] I'm sorry, can you repeat that for me please?
[CUSTOMER][NEUTRAL] Whether the primary care physician referral is required or not.
[AGENT][NEUTRAL] No, it's not required.
[CUSTOMER][POSITIVE] OK. Thank you so much [PII]or that time, just for
[AGENT][NEUTRAL] This is not the primary insurance.
[CUSTOMER][NEUTRAL] So, can you please just confirm whether you follow the primary guidelines or not?
[AGENT][NEUTRAL] So we file follow our own guidelines.
[AGENT][NEUTRAL] How the policy is written.
[CUSTOMER][NEUTRAL] So you follow your own guidelines, right?
[AGENT][NEUTRAL] Right how policy is written.
[CUSTOMER][NEUTRAL] OK. May I know the mailing address?
[AGENT][NEUTRAL] Yes ma'am, that is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's in [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] May I know the payer ID?
[AGENT][NEUTRAL] Payer ID is 60801.
[CUSTOMER][NEUTRAL] 60801, right?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK. Thank you so much for that. And uh just for the confirmation, no copay, no uh deductible, no co-insurance, now the pocket plan costs 100%, right? And coming to the visit limit. It's based on medical necessity, authorization that not required, am I right?
[AGENT][NEUTRAL] Right, the policy pays $1000 per calendar year for outpatient services for the physical therapy.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Is a covered facility.
[AGENT][NEUTRAL] No authorization is needed.
[AGENT][NEUTRAL] This is not the primary insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So patient no need to make any amount, right?
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] The patient what, please?
[CUSTOMER][NEUTRAL] A patient no need to pay any amount, right?
[AGENT][NEUTRAL] Not today. Uh, it depends on how, how it comes back after it's been processed.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] I can't say the patient is not gonna pay because of the claim hasn't been sent.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. These are all the final uh benefits, right? No deductible. OK. Could you please spell out your name?
[AGENT][NEUTRAL] Yes, it's [PII]
[CUSTOMER][NEUTRAL] What is the last name initial?
[AGENT][NEUTRAL] It's A.
[CUSTOMER][NEUTRAL] Sorry, could you please repeat again? Your voice is not clear.
[AGENT][NEUTRAL] It's A.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] You're very welcome. Is there anything else, Miss [PII], I can help you with before we go?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, sorry for the interruption. If you don't mind, could you please repeat again the benefits from the beginning, uh, because, uh,
[CUSTOMER][NEGATIVE] Your voice is getting in and out. I can't understand the benefits clearly.
[AGENT][NEUTRAL] The patient and this is just to verify benefits it's not a guarantee of payment.
[AGENT][NEUTRAL] The Patient has an outpatient benefit amount of $1000 per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So this $1000 plan covers, right? Mm.
[CUSTOMER][NEUTRAL] For the first visit?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello.