AccountId: 011433970860
ContactId: 98dffa2d-d8da-467a-8675-07506f458c50
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 258769 ms
Total Talk Time (AGENT): 143616 ms
Total Talk Time (CUSTOMER): 65154 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/98dffa2d-d8da-467a-8675-07506f458c50_20250227T15:47_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, good morning, [PII]. I'm calling from the outpatient therapy at Montsina. I need to check the benefits for physical therapy, uh, for one of my patients. He has Medicare as a primary. You guys follow Medicare guidelines?
[AGENT][NEUTRAL] We do not
[AGENT][NEUTRAL] This is
[CUSTOMER][NEUTRAL] You do not?
[AGENT][NEUTRAL] No, ma'am. You're wanting to check benefits and eligibility for a member, is that correct? For physical therapy? Yes, I can help you with that. And my name is [PII]
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh, [PII], oh, I'm sorry.
[AGENT][NEUTRAL] Uh-huh. And your name again?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] How do you spell it?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And [PII], what is the callback number for you, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And what is the member's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] It's 02505698 M.
[CUSTOMER][NEUTRAL] L 7.
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[AGENT][NEUTRAL] OK, [PII], any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] OK, thank you
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so he is the subscriber on this supplemental policy, [PII], and it is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And on this supplemental policy, uh, let's see. Give me just a moment to look at something, please.
[AGENT][NEUTRAL] OK, so this was a supplemental or is a supplemental policy to his major medical insurance, which is Cigna.
[CUSTOMER][NEUTRAL] Uh huh
[AGENT][NEUTRAL] So this is a supplemental policy to that.
[CUSTOMER][NEGATIVE] OK, so whatever and that doesn't pay you guys will cover.
[AGENT][NEUTRAL] No, ma'am, no, that this policy is designed to help with co-pays, deductibles and co-insurance amounts of covered services. And you said this is for outpatient?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Outpatient physical therapy.
[AGENT][NEUTRAL] Therapy.
[AGENT][NEUTRAL] OK, so the outpatient benefit maximum per calendar year for covered outpatient services is $2500 with no outpatient deductible per cover person per calendar year. When you all file a claim, [PII], with APO you will also need to include a copy of his primary insurance company's explanation of benefits for us to review as well.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then once we have processed our claim.
[AGENT][NEUTRAL] We do have a portal that you can check claim status in and should also be able to access our EOB by going to [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, uh, may I have the reference number for the call please?
[AGENT][NEUTRAL] Yes, ma'am, you would use my name along with today's date.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK. And is there anything else I can help you with? Oh, you're welcome.
[CUSTOMER][POSITIVE] OK, thank you so much no that's all I need.
[AGENT][POSITIVE] OK, well then, thank you again for calling APO. Have a great day.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.