AccountId: 011433970860
ContactId: ad4d94cf-1b57-4b43-9c39-5a7079780bef
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 366260 ms
Total Talk Time (AGENT): 153462 ms
Total Talk Time (CUSTOMER): 132393 ms
Interruptions: 4
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/11/ad4d94cf-1b57-4b43-9c39-5a7079780bef_20250611T18:18_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, ma'am.
[CUSTOMER][NEUTRAL] Hi, my name is [PII].
[AGENT][NEUTRAL] Uh, I'm sorry, you said your name is [PII]?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, uh, what can we help you with today?
[CUSTOMER][NEUTRAL] Yeah, looking for the eligibility and benefits for physical therapy.
[AGENT][NEUTRAL] OK, I can check those physical therapy benefits for you. Uh, [PII], can I get a good callback number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Thank you. And do you have that policy number?
[CUSTOMER][NEUTRAL] Yes. 025.
[CUSTOMER][NEUTRAL] 40133.
[AGENT][NEUTRAL] OK and then uh what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that. So this policy is active. Effective date was [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And this is a secondary medical policy, so it is designed to help with co-pay, deductible and co-insurance after major medical pays. If you'll give me one moment, I will see if uh physical therapy is a covered benefit under this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, I appreciate your patience, [PII], and of course I will let you know verification of coverage is not a guarantee of payment for claims. Uh, so under this policy, physical therapy in a physical therapy facility or a physician's office is covered under their outpatient benefit. Their outpatient benefit, uh, it's on a per calendar day basis, it pays $1000 max per day.
[CUSTOMER][NEGATIVE] Uh, sorry, you're cutting in and out.
[AGENT][NEUTRAL] Physical therapy is covered under their outpatient benefits. The outpatient benefit is $1000 max per calendar day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. You mean, uh, you will cover up to $1000?
[AGENT][NEUTRAL] Correct, towards co-pay, deductible or co-insurance after major medical pays.
[CUSTOMER][NEUTRAL] I use Canary insurance.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] The, are you scary insurance or primary insurance?
[AGENT][NEUTRAL] This is secondary.
[CUSTOMER][NEUTRAL] This is a secondary to Medicare, right?
[AGENT][NEUTRAL] Uh, uh, whoever they have as their primary.
[CUSTOMER][NEUTRAL] OK. Whatever the bill to the patient, you will cover up to 1000.
[AGENT][NEUTRAL] To co-pay, deductible and co-insurance.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] After their primary pays.
[CUSTOMER][NEUTRAL] OK. And uh
[CUSTOMER][NEUTRAL] OK. Once the patient met is $1000 then it, it will cover 100% or all charges go to the patient? On $1000 has been met?
[AGENT][NEUTRAL] It pays up to it pays up to $1000 per calendar day.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And after that, if patient met 1000 before the calendar year or before the calendar year to met, so then it goes to the, the charges go to the patient, scary will not cover.
[AGENT][NEUTRAL] We don't
[AGENT][NEUTRAL] We don't say what is patient responsibility that would be up to the provider.
[CUSTOMER][NEUTRAL] OK. And what is the claim mailing address?
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] That is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] And that is in [PII].
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Zip code?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] [PII]
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK. And uh is there any uh authorization requirement or visit limitations?
[AGENT][NEUTRAL] Now,
[AGENT][NEUTRAL] No, no authorization is required as long as major medical is willing to pay this policy can.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. Thank you. You will cover up to $1000.
[AGENT][NEUTRAL] Her calendar day.
[CUSTOMER][NEUTRAL] Per calendar day, it is for the, uh, per day or?
[AGENT][NEUTRAL] Per day, yes, there is no yearly maximum, just the daily maximum of $1000.
[CUSTOMER][NEUTRAL] Per year.
[CUSTOMER][NEUTRAL] OK, 1000 per calendar day. OK. Thank you. Can you spell out your name?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Sure, it's [PII]. Oh, was there anything else I could help you with?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEGATIVE] No, initial of lasting.
[AGENT][NEUTRAL] Last initial is A.
[CUSTOMER][NEUTRAL] Call reference number?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Of course, thanks for calling UPL have a great rest of your day.