AccountId: 011433970860
ContactId: 9d4c7af7-1e4c-49e6-a62c-4fe1e4900112
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 246289 ms
Total Talk Time (AGENT): 129915 ms
Total Talk Time (CUSTOMER): 72131 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/9d4c7af7-1e4c-49e6-a62c-4fe1e4900112_20250619T18:12_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from outpatient physical therapy with Jefferson, um, in regards to one of, um, your patients.
[AGENT][NEUTRAL] OK, are we just, uh, checking eligibility?
[CUSTOMER][POSITIVE] Yes, and benefits.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Got it. Uh, physical therapy benefits?
[CUSTOMER][NEUTRAL] Yeah, for outpatient hospital.
[AGENT][POSITIVE] Got it. I'll take a look at that for you. uh, [PII], can I get a good call back number from you first in case we're disconnected please?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] I do. It's 02639836.
[AGENT][NEUTRAL] OK, and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Um, [PII] Date of birth [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. So this policy is active, uh, 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. Give me one moment, let me take a look.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And of course I will let you know verification of coverage is not a guarantee of payment for claims. So we are checking you did say um sorry, just so that I understand this was physical therapy in an outpatient facility, correct? Or is it an actual physical therapy facility?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's um hospital outpatient physical therapy.
[AGENT][NEUTRAL] OK, so is it an actual physical therapy facility though?
[CUSTOMER][NEUTRAL] It's hospital-based.
[CUSTOMER][NEUTRAL] Um, yes, but it's, it's based out of the hospital.
[AGENT][NEUTRAL] I see, OK, um, so yes, per these uh kinds of policies they do state, um, physical therapy in a physical therapy facility is what would be covered, um.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And so their outpatient benefit pays on a per calendar day basis. It is up to $500 per calendar day. There is no yearly maximum.
[CUSTOMER][NEUTRAL] And that's for physical therapy?
[AGENT][NEUTRAL] Uh, that's outpatient, that's just their outpatient benefits anything considered outpatient.
[CUSTOMER][NEUTRAL] Oh, OK, um.
[AGENT][NEUTRAL] And again that's uh co-pay deductible and co-insurance after major medical pays.
[CUSTOMER][NEUTRAL] Um, can you look up and see if um.
[CUSTOMER][NEUTRAL] We can even take this like if if if she's covered I mean I've never heard of it before.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] No worries, yeah, so this policy, it does not have its own set network. It follows major medical, so whoever they have as their primary, as long as they're willing to pay this policy can.
[CUSTOMER][NEUTRAL] I see, OK.
[CUSTOMER][NEUTRAL] Alright and you said it was a calendar year or benefit year?
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] This is um it is on a calendar year but however their outpatient benefits pays per calendar day.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] There's not a yearly maximum for the outpatient benefit.
[CUSTOMER][NEUTRAL] I see, OK, so it pays 500 per day.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Alright, and do you have a reference number for this call?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date. Um so my name is spelled [PII] Was there anything else I can help you with?
[CUSTOMER][POSITIVE] No, that's all thank you.
[AGENT][POSITIVE] Of course, thanks for calling APL have a great rest of your day.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][POSITIVE] Thank you bye bye.
[CUSTOMER][NEUTRAL] Bye bye.