AccountId: 011433970860
ContactId: ade51c7d-a759-4d5b-a9b6-ec22e83d1478
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 293709 ms
Total Talk Time (AGENT): 140429 ms
Total Talk Time (CUSTOMER): 85262 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=1.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/21/ade51c7d-a759-4d5b-a9b6-ec22e83d1478_20250221T17:25_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is speaking. May I help you?
[CUSTOMER][NEUTRAL] Yes, hi, my name is [PII], and I need to verify a, a patient's physical therapy benefits please, using this, this is a supplemental plan.
[AGENT][NEUTRAL] OK, I can verify benefits for you. And [PII], what is that policy number, please?
[CUSTOMER][NEUTRAL] It is 02552669 M as in Mike L as in Lima number 8.
[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] Sure, [PII].
[AGENT][NEUTRAL] And the patient's name, date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, I'm showing that policy number you gave us terminated, so I can give you the current number when you're ready.
[CUSTOMER][NEUTRAL] Oh, OK, yes please.
[AGENT][NEUTRAL] OK, it is 231-295-7.
[AGENT][NEUTRAL] And so effective, um, [PII], policy is active. And you say you're needing physical therapy benefits, is that correct?
[CUSTOMER][NEUTRAL] Yes, and you said this was [PII].
[AGENT][POSITIVE] Uh, it's effective date, yes, sir.
[CUSTOMER][NEUTRAL] The effectively, oh wow, OK, yeah, this car is old then.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And give me one moment, let me pull up their policy.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I apologize. I know some of our policies cover physical therapy, some don't. I just wanna pull up the plan and see.
[CUSTOMER][NEUTRAL] Yeah, and this is still a supplemental plan, right? Because this patient has a Cigna as primary, OK.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Yes, it's still a second uh dairy. Let's see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright thank you.
[CUSTOMER][NEUTRAL] And do it when you get a chance, would you be able to tell me the group number to this.
[AGENT][NEUTRAL] Uh, yes.
[CUSTOMER][NEUTRAL] Plan
[AGENT][NEUTRAL] Uh, so group number 16487. Group name Philip and Patricia's Frost Museum.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] That's pretty cool.
[CUSTOMER][POSITIVE] OK, thank you, yeah.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] OK, and I do show physical therapy is covered under the policy as outpatient, um, not a guarantee of payment, just a verification of coverage. With this policy as secondary, it helps with primary insurance deductible, co-pay, co-insurance, and has a benefit max up to $250 per calendar day.
[CUSTOMER][POSITIVE] Great.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And let me double check cause, oh, it must have been some type of other therapy, not physical. Give me one moment.
[AGENT][NEUTRAL] OK, yes. It's, uh, physical therapy is covered as outpatient. It pays up to $250 per calendar day of what the primary applies towards deductible, co-pay, or co-insurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Great, is there a cap at all, like a yearly cap at all, or is that just $250 per day?
[AGENT][NEUTRAL] Uh, just 250 for a day. So I guess it would depend on, um, if there's a limit as far as the major medical.
[CUSTOMER][POSITIVE] OK, good.
[CUSTOMER][NEUTRAL] Yeah, yeah, no, for physical therapy this lady only has a $50 copay as a primary, so she'll be covered, um, then if I can just get a call reference number from you please, there, um, there's no authorization or pre-certification needed, right, for the secondary plan.
[AGENT][NEUTRAL] Uh, no, sir.
[CUSTOMER][NEUTRAL] No, OK, and then just a call reference number please.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Uh, we don't give reference numbers, but if you like, you may use my name in today's date.
[CUSTOMER][NEUTRAL] OK, um, what was your first name again? I'm sorry.
[AGENT][POSITIVE] Very fine. It's [PII], last initial [PII].
[CUSTOMER][POSITIVE] OK, [PII]. OK, thank you, [PII]. I appreciate your help.
[AGENT][POSITIVE] You are welcome. Thanks for calling [PII]. Have a great day, Mr. [PII].
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][NEUTRAL] Bye.