AccountId: 011433970860
ContactId: ae7ad822-053d-4e44-9217-4e35eb775e81
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 531729 ms
Total Talk Time (AGENT): 148580 ms
Total Talk Time (CUSTOMER): 139061 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/27/ae7ad822-053d-4e44-9217-4e35eb775e81_20250527T14:16_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from provider's office to check on patient's benefits.
[AGENT][POSITIVE] I can help you with uh benefits. Can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes. It's gonna be [PII], no extension.
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, I do. Uh, it's gonna be 01829134 M as in Mary, L as in Lima, number 7.
[AGENT][NEUTRAL] One moment while I look that up for you.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Can I get you to verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, it's, it's [PII] of [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, this is a meddling policy, so it is a secondary gap policy, meaning that we will need a primary explanation of benefits before you can file for this claim.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] It is only secondary to the primary insurance. So if the primary insurance denies this, denies the claim, then this insurance will deny a claim as well. It looks like this policy was effective.
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] From [PII] and it is active.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, ma'am. I do have some specific question regarding this patient policy. Um, this patient has Cigna as a primary. Um, um, this patient have a physical therapy evaluation to be scheduled for the future appointment. Uh, does this American public life covers the physical therapy?
[AGENT][POSITIVE] I can sure check that for you, one moment.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][NEUTRAL] By the way, for the phys um outpatient hospital facility setting processes.
[AGENT][NEUTRAL] Were you wanting to know
[AGENT][NEUTRAL] I'm sorry, could you repeat that?
[CUSTOMER][NEUTRAL] Um, it's for the place of service of outpatient facility or or hospital outpatient facility, place of service.
[AGENT][NEUTRAL] Um, yes, they do have outpatient benefits. It's taking just a moment to pull it up though.
[CUSTOMER][NEUTRAL] Yes. Mhm mhm.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, let me see.
[AGENT][NEUTRAL] I'm not seeing anything for physical therapy. Give me just a moment and I'll look up the policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Give me just a moment while I look that up.
[CUSTOMER][POSITIVE] Please take your time.
[AGENT][NEUTRAL] It looks like they do have outpatient benefits for physical therapy performed in a physical therapy facility.
[CUSTOMER][NEUTRAL] Um, you said that this physical therapy covers the benefits for the secondary, right, for the primary, right?
[AGENT][POSITIVE] Right, so as long as the primary also provides benefits for physical therapy, this one will help pick up that and help pick up the leftover.
[CUSTOMER][NEUTRAL] Uh-huh. Um, OK, ma'am. Could you please, um, tell me the exact accumulation, I mean, how much was covered? I mean, uh, what is the lifetime benefits available for this patient? How much was met?
[AGENT][NEUTRAL] Let me see.
[CUSTOMER][NEUTRAL] You understand my question, ma'am? Mm.
[AGENT][NEUTRAL] You wanna know if they've used up any of their benefits yet?
[CUSTOMER][NEUTRAL] Yes, but, uh, I mean, uh, how much was met, I, uh, how much was the maximum allowed amount, uh benefits allowed for this member and how much was met, yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It looks like they have an outpatient benefit maximum of up to $500 per covered person per calendar day.
[AGENT][NEUTRAL] So unless she's being seen um because it's per day, she has up to $500. Now that is an explanation of benefits and not necessarily a guarantee of payment, but because it's per calendar day, uh, she should be fine as long as she's not seeing two different outpatient facilities at the same time.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Is the $500 has been met, uh, or uh?
[AGENT][NEUTRAL] Not to date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. Um, you're saying the American public life covers the physical benefits for the primary and the second is, is being covered, right?
[AGENT][NEUTRAL] Right, the primary will need to be billed first.
[CUSTOMER][POSITIVE] Yes, all right.
[AGENT][NEUTRAL] Right, right.
[CUSTOMER][POSITIVE] Thank you so much. Uh, thank you so thank you so much. Um, but wait, can I get your um name and the call reference number?
[AGENT][NEUTRAL] We don't have a call reference number, but you can use my name and last initial in today's date. So [PII], in today's date.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Thank you, [PII]. Thank you so much. Have a nice day. Thank you for assistance.
[AGENT][POSITIVE] Have a great day. Thank you for calling ATL.
[CUSTOMER][NEUTRAL] Um, sorry, sorry for, uh, you said the American, sorry for the interruption, ma'am. Are you, um, is American Public life effective date please one more time? I didn't catch it.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] I'm sorry, what was that?
[CUSTOMER][NEUTRAL] What's the effective date for the policy for the American APL?
[AGENT][NEUTRAL] Oh, OK, give me just a moment.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] [PII]. Thank you. Thank you, [PII]. Have a nice day. Bye.
[AGENT][NEUTRAL] Yes sir.
[AGENT][POSITIVE] Have a great day bye.
[CUSTOMER][NEUTRAL] You too.