AccountId: 011433970860
ContactId: b3a208c7-50fe-4f17-8e77-ca01762898a6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 246309 ms
Total Talk Time (AGENT): 129357 ms
Total Talk Time (CUSTOMER): 94226 ms
Interruptions: 1
Overall Sentiment: AGENT=1.9, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/b3a208c7-50fe-4f17-8e77-ca01762898a6_20250311T15:29_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] calling from Kansas City Orthopedic Institute, and I was seeing if you could help me verify.
[AGENT][NEUTRAL] Uh oh, [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, the phone just went in and out after you said, I was wondering.
[CUSTOMER][NEUTRAL] Oh, so
[CUSTOMER][NEUTRAL] OK, sorry.
[AGENT][NEUTRAL] It's OK. Can you say that one more time for me?
[CUSTOMER][NEUTRAL] OK, yes, I'm calling to see if you could help me verify benefits on a member.
[AGENT][NEUTRAL] Oh, sure. And may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][POSITIVE] Thank you, and I'll be more than happy to help you with the benefits and uh may I have the member's policy number?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yes, it is 02480526.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. I am showing that the policy is active. It's been effective since [PII].
[AGENT][NEUTRAL] And what type of benefits did you want to go over today?
[CUSTOMER][NEUTRAL] Um, it would be for physical therapy. The patient stated that he has, uh, United Healthcare as his primary, so I wasn't sure how, I, when it, with this being his secondary, how it's going to cover or, or what the process is with that.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, so the, um, so once we're put down as secondary, you'll go ahead and do United Healthcare, they'll apply based on their policy benefits, and then if there's anything outstanding, um, it will be sent to us automatically, well, you always send it to us after primary sent it to you, um, and then we'll apply based on our policy, um, benefits. So for this policy, the outpatient calendar year max is $1000.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK, and has he used, OK.
[AGENT][NEUTRAL] I'm trying to see if her physical, I'm sorry.
[CUSTOMER][NEUTRAL] I was gonna say has he used any of that yet or?
[AGENT][NEUTRAL] Um, I can check for you. Let me see if there's a max for physical therapy. Hold on one second. Yeah, I don't see a max. So, for this policy, there's two things. So, so under the outpatient benefits, you have the physical therapy and a physical.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] facility. If you all are considered in office, the member also has the office treatment writer, so any treatment in the office, as long as it's not cosmetic could be covered up to that $1000. And let me see if they've used any.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And he has not used any of the um
[AGENT][NEUTRAL] Balance for 2025, so he still has the full $1000.
[CUSTOMER][NEUTRAL] OK, so now in our, we bill as a facility, so when he um comes in, we do with, he would owe $124 for each visit through United Healthcare, um, and then we, we bill UnitedHealthcare, the, the, the, the rest. So I guess we still just collect from the patient and then bill United Healthcare and then bill you secondly.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, UnitedHealthcare requires a co-pay or deductible or something to be paid upfront, the member is gonna have to pay that, um, you know, to get the services and then on the back end, once you receive that claim to be reimbursed or something, we can handle it on the back end.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][POSITIVE] OK, OK, perfect, thank you so much for clarifying that.
[AGENT][POSITIVE] You're very welcome, [PII]. Was there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Nope, that'll be it.
[AGENT][POSITIVE] Alright, well, thanks for calling [PII]. I hope you have a great week.
[CUSTOMER][NEUTRAL] You too. Bye.
[AGENT][POSITIVE] Thank you. Bye-bye.