AccountId: 011433970860
ContactId: bd322313-ad3b-4868-84b4-67b7d4ba2f76
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 365049 ms
Total Talk Time (AGENT): 153674 ms
Total Talk Time (CUSTOMER): 175639 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/07/bd322313-ad3b-4868-84b4-67b7d4ba2f76_20250207T15:12_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from Carolina Sports Care and Physical Therapy. How are you today?
[AGENT][NEUTRAL] I am fine, Ms. [PII]. It's Friday. How are you?
[CUSTOMER][NEUTRAL] Yes, it is.
[CUSTOMER][POSITIVE] I'm ready for the weekend too, you know, OK.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Great. Well, I'm calling for benefits. Um, this is a secondary insurance and so I just wanted to um get the benefits for that.
[AGENT][NEUTRAL] OK, I can verify benefits for you. Uh, what's that policy number, Ms. [PII]?
[CUSTOMER][NEUTRAL] Sure, it is um.
[CUSTOMER][NEUTRAL] 02592443.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, it is um [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. Let's see, and verify that patient's name, date of birth.
[CUSTOMER][NEUTRAL] Um, the patient's name is, um, [PII], um, and she goes by [PII]. Her date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm showing her effective date is [PII]. She is active on the policy.
[AGENT][NEUTRAL] Excuse me, and what benefits are you needing for the patient?
[CUSTOMER][NEUTRAL] Um, well, she has a primary which is Blue Cross Blue Shield, and I wanted to know how uh you coordinate with that.
[AGENT][NEUTRAL] OK, let me see give me one moment.
[AGENT][NEUTRAL] Well, with this policy is secondary, what it does, it helps with primary insurance deductible, co-pay or co-insurance up to their max benefit. And I'm trying to pull up the plan. Is this for outpatient or in hospitals?
[CUSTOMER][NEUTRAL] This is an outpatient service, um, physical therapy, and, um.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Does it cover copay as well? You say copay, um, deductible and co-insurance?
[AGENT][NEUTRAL] Uh, give me one moment, see.
[AGENT][NEUTRAL] OK, and I do show that physical therapy uh is covered under the plan as outpatient and um not a guarantee of payment, just verification of coverage insured has a benefit max up to $4200 per calendar year.
[AGENT][NEUTRAL] And it looks like they do have a $1500 deductible per calendar year.
[CUSTOMER][NEUTRAL] OK, alright, um.
[CUSTOMER][NEUTRAL] You gave me a lot of information. OK, so you said, you said 4.
[CUSTOMER][NEUTRAL] OK, what was the co-pay?
[AGENT][NEUTRAL] Uh, there's not a co-pay. Um, with this policy, we pick up what primary applies towards deductible, co-pay, or co-insurance, and they have a 4 $200 benefit per calendar year.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And there's a $1500 deductible that's per calendar year.
[AGENT][NEUTRAL] Outpatient
[CUSTOMER][NEUTRAL] OK, so let's say that um their primary is picking up um.
[CUSTOMER][NEUTRAL] That has a copay on it, would they pick up the copay?
[AGENT][NEUTRAL] Yes, so what's the primary applies for deductible co-payer.
[CUSTOMER][NEUTRAL] Alright, well, is this before or after the, the, yeah, that's what was good. I'm sorry to interrupt. Um, I just was trying to figure out, OK, so they have to meet a deductible with that or?
[AGENT][POSITIVE] Oh, I'm sorry.
[AGENT][NEUTRAL] Like
[CUSTOMER][NEUTRAL] Out of pocket.
[AGENT][NEUTRAL] Uh, with us, yes, ma'am. They have to meet up to that $1500 deductible with our company and then after that we pay up to that $4200.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And has anything applied to that 1500?
[AGENT][NEUTRAL] Uh, no, ma'am. I don't show that she uses any of her benefits for this year.
[AGENT][NEGATIVE] Nor met her deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so, um, pretty much you're not going to cover, uh, anything.
[CUSTOMER][NEUTRAL] Until after the 1500 is met.
[AGENT][NEUTRAL] Uh, once she's met that deductible, then we'll pay up to that 4200. Yes, ma'am.
[CUSTOMER][NEUTRAL] Oh wow, that is OK. All right, so she don't really have a secondary got you until then because you know 1500, does she go um because her.
[CUSTOMER][NEUTRAL] Um, she does have a copay on her primary.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And um and that's $90 a visit.
[CUSTOMER][NEUTRAL] So,
[AGENT][NEUTRAL] Yeah. Well, we don't know if anything else comes in, uh, for, hopefully, she wouldn't have any other major services or anything, but if she was to have any outpatient or in-hospital procedures, then I can go towards that deductible. But, yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and so her effective date is [PII].
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Uh, yes, ma'am.
[CUSTOMER][NEUTRAL] OK. And your name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, and that's all I need to know is, and, and the only limit is the out of pocket, the 4200, right?
[AGENT][POSITIVE] Uh, correct.
[CUSTOMER][NEUTRAL] OK, and that's a calendar year?
[AGENT][NEUTRAL] Uh, yes, ma'am.
[CUSTOMER][NEUTRAL] Alright, alright, thank you that's all I needed to know. Do you have a reference number for this call?
[AGENT][NEUTRAL] Uh, no, ma'am, but if you like, you may use my name. It's [PII].
[CUSTOMER][POSITIVE] OK, perfect. Alright, thank you, [PII], you've been a big help.
[AGENT][POSITIVE] You, you're welcome and thank you for calling APL Ms. [PII]. Have a great weekend.
[CUSTOMER][NEUTRAL] All right, mm, you too, bye.
[AGENT][NEUTRAL] Bye.