AccountId: 011433970860
ContactId: 9ba3b84c-5354-44ed-a9c6-5e5211da5f2e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 244279 ms
Total Talk Time (AGENT): 121062 ms
Total Talk Time (CUSTOMER): 53659 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/9ba3b84c-5354-44ed-a9c6-5e5211da5f2e_20250210T14:40_UTC.wav
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[AGENT][POSITIVE] Good Morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, I need to verify for outpatient hospital based physical therapy.
[AGENT][NEUTRAL] OK, I can verify benefits for you. And your name is?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and Ms. [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] 02265946
[AGENT][POSITIVE] OK, thank you so much. Give me one moment.
[AGENT][NEUTRAL] OK, and do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, it is [PII] and that's a direct line.
[AGENT][NEUTRAL] OK, and verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, give me a moment.
[AGENT][NEUTRAL] OK. I'm showing that policy number you gave it terminated [PII]. Um, however, she does have a current policy and I can give that to you when you're ready.
[CUSTOMER][POSITIVE] OK, I'm ready.
[AGENT][NEUTRAL] OK, I'm sorry, policy number is 2556231.
[AGENT][NEUTRAL] Effective [PII] and the policy is active. And you say you're calling to verify outpatient physical therapy benefits, is that correct?
[CUSTOMER][POSITIVE] Correct, and we build a facility.
[AGENT][NEUTRAL] OK, give me a moment.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] See.
[AGENT][NEUTRAL] I apologize my computer is really slow this morning.
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] OK, uh, physical therapy is covered under the policy as outpatient, uh, not a guarantee of payment, just a verification of coverage. With this policy, we are secondary. We help with primary insurance deductible, co-pay, and or co-insurance, and the patient has a benefit max of up to $8150 per calendar year.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there any visit limitation?
[AGENT][NEUTRAL] Uh, no, I guess it would depend on the primary. Uh, we just pay up to that benefit max.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And you said they're the out of pocket 8150.
[AGENT][NEUTRAL] Uh, that's how much we pay. It's up to 8150 of what primary insurance applies towards deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Alright, I understand.
[CUSTOMER][NEUTRAL] And let's see here, can I get a claims address?
[AGENT][NEUTRAL] Uh yes, ma'am. It is [PII], O Lord words [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, and can I get a reference number for this call?
[AGENT][NEUTRAL] Uh, we don't give reference numbers, but if you like, you may use my name at today's date.
[CUSTOMER][POSITIVE] OK alrighty thanks so much for your help today I appreciate it.
[AGENT][POSITIVE] Alright, you're welcome, Ms. [PII], and thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Alright you too bye bye.
[AGENT][NEUTRAL] Bye.
[AGENT][NEUTRAL] Mhm