AccountId: 011433970860
ContactId: 99d63c89-ab2b-49f7-ba44-f7a306e12495
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 508869 ms
Total Talk Time (AGENT): 212960 ms
Total Talk Time (CUSTOMER): 164494 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/99d63c89-ab2b-49f7-ba44-f7a306e12495_20250320T20:12_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, yes. Hi [PII]. My name is [PII]. I'm calling from Axis Physical Therapy, um, in the state of [PII], and I'm wanting to verify outpatient physical therapy benefits for a member.
[AGENT][NEUTRAL] OK, [PII], I can help you with outpatient physical therapy benefits, um.
[AGENT][NEUTRAL] You have a good callback number?
[CUSTOMER][NEUTRAL] It is [PII] with no extension that's my direct line.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Uh yes, it is 01663 consecutive 300.
[AGENT][NEUTRAL] OK great thank you. Do you have the patient name and date of birth?
[CUSTOMER][NEUTRAL] It is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, it's not a guarantee of payment, just a basic outline of the policy. Um, let's see, do you need eligibility as well or just the benefits?
[CUSTOMER][NEUTRAL] Um, eligibility as well, and we bill as professional in off in the office setting as well, just gonna have one.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, let's see, she is.
[AGENT][NEUTRAL] and effective [PII].
[AGENT][NEUTRAL] And let's see what her benefits are.
[AGENT][NEUTRAL] Get that pulled up.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said this is built in a physician's office or is it a the physical therapy facility?
[CUSTOMER][NEUTRAL] We bill as professional in office.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] She
[AGENT][NEUTRAL] As coverage for a physical therapy facility.
[AGENT][NEUTRAL] And that's coverage for 5000 per calendar year.
[CUSTOMER][NEUTRAL] And is that a deductible?
[AGENT][NEUTRAL] Um, that's the benefit. There's no deductible.
[CUSTOMER][NEUTRAL] OK, so no deductible.
[AGENT][NEUTRAL] But like I said, it does specify physical therapy facility, so.
[CUSTOMER][NEUTRAL] And you said
[CUSTOMER][NEUTRAL] Is there any other benefit? So just you guys cover 5000.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Or calendar year?
[AGENT][NEUTRAL] This is, this is like a, yeah, it's like a supplemental policy so we coordinate with the major medical, um, and that we would require the explanation of benefits from the major medical policy.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it's, it's a supplemental policy in excess of that primary policy, it covers up to 5000.
[AGENT][NEUTRAL] For calendar year for outpatient benefits and then it has specific benefits covered under that one of which is physical therapy facility benefits.
[AGENT][NEUTRAL] Does that make sense?
[CUSTOMER][NEUTRAL] Uh, a little bit. So will the patient be so patient has Blue Cross Blue Shield. Will she be responsible for anything?
[AGENT][NEUTRAL] Well, so we don't determine, yeah, so we don't determine patient responsibility, but we potentially could cover some coinsurance or deductible based on what the primary processes. So based on whatever Blue Cross Blue Shield processes.
[CUSTOMER][NEUTRAL] If you guys pick up
[CUSTOMER][NEUTRAL] OK, so we have to process, so we'll process through whatever Blue Cross Blue Shields and then you'll pick up whatever is possibly remaining and then the patient could possibly have a balance.
[AGENT][POSITIVE] Correct, yes. So, yeah, it works in coordination with that primary insurance, yup.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Works.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Huh?
[CUSTOMER][NEUTRAL] Does she have a visit limit with this supplement?
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Or any authorization required.
[AGENT][NEUTRAL] He does not have a visit limit.
[AGENT][POSITIVE] No prior off required and no visit limit for that specific benefit.
[CUSTOMER][NEUTRAL] OK, and no business on that.
[CUSTOMER][POSITIVE] So basically it's kind of the luck of the draw whatever is the remaining is gonna fall to the patient responsibility basically.
[AGENT][NEUTRAL] Yeah and I can look and see do you want me to see if she's used any of that this year?
[CUSTOMER][POSITIVE] Yeah, if you could, I know she said that she was attending advanced training rehab, um, um, and she attended there for 5 visits, so, but yeah, if you can see how much she's used, that'll be great.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] So so far this year I do not show any.
[AGENT][NEUTRAL] And if it's used.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Any, so none of that 5000 has been used.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] And does this run on a plan year or a calendar year?
[AGENT][NEUTRAL] Now let's see.
[AGENT][NEUTRAL] It's calendar year.
[CUSTOMER][POSITIVE] Calendar year OK perfect.
[CUSTOMER][NEUTRAL] Alright and then um could you give me the claims billing address and then a call reference number?
[AGENT][NEUTRAL] Yeah, absolutely. So our claim billing address, let me get that pulled up. So it's APL [PII] and that is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Um, just to let you know too, you can also upload claims at our portal, um, which is [PII].
[AGENT][NEUTRAL] And then are you, do you need maybe a payer ID or a fax or is that information sufficient?
[CUSTOMER][NEUTRAL] Yeah, if we can get a payer ID yeah, can I get a payer ID please?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, payer ID is 60801.
[AGENT][NEUTRAL] And is there anything else that I can help with? Uh, I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] Same question for you, [PII].
[CUSTOMER][NEUTRAL] Yeah, um, the patient, so the patient doesn't have to meet like, cause you know, with some supplement policies like the patient has to meet the deductible with their primary before the secondary or the supplement picks up. Is that how it works with you all, or, or is that completely different?
[AGENT][NEUTRAL] So we, you know, for instance if so if a primary has a we just need to see that the primary has processed the claim and then we coordinate based on however they've processed so for example if for some reason primary didn't cover this, we're not gonna cover either but if they did process the claim and consider it we're going to process as secondary according to this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Does that make sense?
[CUSTOMER][POSITIVE] Yep, that makes perfect sense.
[AGENT][POSITIVE] OK, good.
[CUSTOMER][NEUTRAL] Yeah, so if they deny then you would deny. OK, got it.
[AGENT][NEUTRAL] That is correct. Yes, yeah. Primary has to consider the claim, um, for us to consider it as well.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] OK great and then could I get a good call reference number?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Oh yeah, um, it's just my first name, last initial it's [PII], last initial is [PII], and then today's date.
[CUSTOMER][POSITIVE] Alright perfect thank you so much [PII]. I really appreciate it.
[AGENT][POSITIVE] OK, thank you for calling APL you have a wonderful day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye.