AccountId: 011433970860
ContactId: bd43fc16-fd0f-4f6b-9358-16b835075906
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 322239 ms
Total Talk Time (AGENT): 128946 ms
Total Talk Time (CUSTOMER): 142461 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/bd43fc16-fd0f-4f6b-9358-16b835075906_20250203T17:43_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, Mr. [PII]. My name is [PII]. Last initial is [PII]. I'm not sure if I'm calling the right department, but I'm trying to verify a member's benefits for physical therapy.
[AGENT][NEUTRAL] May I please have a callback number and then the policy number?
[CUSTOMER][NEUTRAL] [PII] direct line Pa's policy number is A for apple H for Henry 0554275.
[AGENT][NEUTRAL] That's not one of our policy numbers.
[CUSTOMER][NEUTRAL] Give me 1 2nd.
[CUSTOMER][NEUTRAL] That is the subscriber ID that I have here unless it is because it has a primary health plan and a secondary help plan on the card, so maybe you guys are the secondary. I can give you that number.
[AGENT][NEUTRAL] May I have that please?
[CUSTOMER][NEUTRAL] 2180309
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is Nicole [PII] [PII].
[AGENT][NEUTRAL] And you're calling in for physical therapy benefits?
[CUSTOMER][NEUTRAL] Correct, that was the correct policy number that I gave you?
[AGENT][NEUTRAL] Yes, we are considered their supplemental or secondary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] You're welcome. And in regards to this policy, verification of coverage does not guarantee the payment of the claim. The member has up to $6000 per calendar year that will go towards the primary insurance deductible, co-insurance, or co-pay. This policy is for sickness and injury only. It will not cover any type of preventative or wellness.
[AGENT][NEUTRAL] The policy effective date is [PII] and currently active. Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Hold on one second. I was writing as you were speaking, so I just want to confirm what you're telling me. Um, and what is the, are you guys still under Allied or is it a different company?
[AGENT][NEUTRAL] We're American public life.
[CUSTOMER][NEUTRAL] American public life, oh, OK.
[CUSTOMER][NEUTRAL] OK, so the primary must be this one. OK, so you guys are on the American Public Life, um, and just to confirm, so you guys do cover physical therapy, you guys have $6000 that apply towards the primary deductible?
[AGENT][NEUTRAL] Deductible co-insurance, or co-pay for physical therapy.
[CUSTOMER][NEUTRAL] And it's a, so it's a $6000 limit.
[AGENT][NEUTRAL] This is a per calendar year benefit that we will pay out.
[CUSTOMER][NEUTRAL] And once the $6000 has been met, the patient will be responsible for any other charges? or how does that work?
[AGENT][NEUTRAL] Is based off of their primary insurance.
[AGENT][NEUTRAL] But once we make the $6000 that's the only amount that we will pay out.
[CUSTOMER][NEUTRAL] OK, so you guys have a max amount of the $6000 and it, and it applies towards the copay, deductible, co-insurance, and out of pocket or?
[AGENT][NEUTRAL] The out of pocket is the primary insurance deductible, co-insurance, or co-pay. So the primary insurance is gonna state that the patient has a responsibility. As long as it's applied to those categories, we will pay up to that 6000.
[AGENT][NEUTRAL] So once we make that payment up to that 6000 for that calendar year, we will not be able to pay anything else out. So you will have to verify the primary insurance to see what is the member's responsibility for the year.
[CUSTOMER][NEUTRAL] Correct, and out of the $6000 you guys will cover that responsibility.
[AGENT][NEUTRAL] Correct, as long as it's applied to the categories that I've stated.
[CUSTOMER][NEUTRAL] OK, that's what I'm trying to make sure of, and you say that it was a 6000.
[CUSTOMER][NEUTRAL] And is prior authorization or visit limit?
[AGENT][NEUTRAL] No prior authors required. You would get that from the primary insurance.
[CUSTOMER][NEUTRAL] Requiring
[CUSTOMER][NEUTRAL] OK dokey then. Let's see.
[CUSTOMER][NEUTRAL] So and what about a visit limit?
[AGENT][NEUTRAL] It's a, it's a dollar amount limit.
[CUSTOMER][POSITIVE] OK, so no visit limit, just a dollar amount. OK, perfect.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and can I, can I have your name once again and then a reference number for the call.
[AGENT][NEUTRAL] Yes, the reference number will be my first name, [PII], that is spelled [PII] last [PII] today's date.
[CUSTOMER][NEUTRAL] OK, so I have T E R R E K I A H 23 2025.
[AGENT][NEUTRAL] Yes, that would be the reference number.
[CUSTOMER][POSITIVE] Perfect. OK dokey then. Thank you so much, Mr. [PII]. You have an awesome day.
[AGENT][POSITIVE] You're welcome and thank you for calling American Public Library. Have a great day as well.