AccountId: 011433970860
ContactId: b39b0454-8b50-4bbe-8a34-f4e841808c57
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 383809 ms
Total Talk Time (AGENT): 147986 ms
Total Talk Time (CUSTOMER): 143855 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/b39b0454-8b50-4bbe-8a34-f4e841808c57_20250320T21:03_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is. How may I help you?
[CUSTOMER][POSITIVE] Yes, I'm calling to um get benefits on a patient. I realized that this is a secondary policy to a primary policy to the patient presented to us.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Help you with the benefits for this policy, can you please give me your name and your callback number?
[CUSTOMER][NEUTRAL] Sure. My name is [PII]. I'm representing uh Carolina Sports Care and Physical Therapy. Um, the telephone number here is [PII].
[AGENT][POSITIVE] Thank you so much, Ms. [PII]. And what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] OK. It is a minor and his name is [PII]. His date of birth is [PII].
[AGENT][NEUTRAL] And then um do you have the policy number that [PII] is on?
[CUSTOMER][NEUTRAL] Uh, you said the ID number?
[AGENT][NEUTRAL] Yes ma'am, the policy number?
[CUSTOMER][NEUTRAL] Yes, it is 0.
[AGENT][NEUTRAL] It might say inpatient or outpatient sir go ahead.
[CUSTOMER][NEUTRAL] Uh, let me see, let me look at the card. Hold on.
[AGENT][NEUTRAL] Yes ma'am, sure.
[CUSTOMER][NEUTRAL] Because what we have what we have down here is 02592452 and this is for outpatient um benefits.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me pull that policy up quick look at it.
[AGENT][NEUTRAL] I do show that [PII] is on this policy and the policy is active and his effective date is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This is just to verify benefits. It's not a guarantee of payment. Uh, you're correct, this is a supplemental insurance policy that is built secondary. It helps with deductible, co-pay, and co-insurance.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And he has an inpatient benefit amount of $4200 per calendar year and then an outpatient benefit amount also of $4200 per calendar year.
[CUSTOMER][NEUTRAL] OK. You said 4200?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Has he met any of that yet?
[AGENT][NEUTRAL] Let me check for you real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, ma'am, there's nothing been used for the year of [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And let's see, and your name?
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][NEUTRAL] Let me.
[CUSTOMER][NEUTRAL] OK and um so that is the outpatient um.
[CUSTOMER][NEUTRAL] I mean, the out of pocket was the 4200.
[AGENT][NEUTRAL] No, ma'am, that's the benefit that helps with deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK, so that's the benefit max.
[AGENT][POSITIVE] Yes, ma'am, that's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And it pays um 100% of the deductible.
[CUSTOMER][NEUTRAL] Up to 4 up to 42.
[AGENT][NEUTRAL] Well, it's
[AGENT][NEUTRAL] It's based
[AGENT][NEUTRAL] Right, it's based on what the primary pays, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the diagnosis and procedure codes that the primary insurance pays for. So when the, when the claim is submitted, it needs to have the EOB from the primary insurance submitted with it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] Now, um, let's see, but if the max is 4200. And uh this is, um, outpatient physical therapy. Is there any other, um, is there other limits or benefit max?
[AGENT][NEUTRAL] Let me check on physical therapy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] It does cover physical therapy in a physician's office and
[AGENT][NEUTRAL] It falls under the outpatient benefit amount.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it'll pick up the deductible and the coinsurance.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Right. Up to $4200.
[CUSTOMER][NEUTRAL] OK, and
[CUSTOMER][POSITIVE] Perfect. And this is a calendar year, uh, policy?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, and do we have a reference number for this call?
[AGENT][NEUTRAL] Yes, you can use my name. It's [PII] and today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect thank you.
[AGENT][POSITIVE] You're very welcome. Is there anything else, Ms. [PII], I can help you with?
[CUSTOMER][POSITIVE] Uh, no, that's it. Thank you.
[AGENT][POSITIVE] You're very welcome. I hope you have a wonderful day and thanks for calling APL.
[CUSTOMER][NEUTRAL] OK. You too. Bye.
[AGENT][NEUTRAL] Bye-bye.