AccountId: 011433970860
ContactId: c8b2a177-e435-424c-841b-ebfa2954373e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 507869 ms
Total Talk Time (AGENT): 179298 ms
Total Talk Time (CUSTOMER): 147655 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/c8b2a177-e435-424c-841b-ebfa2954373e_20250129T15:21_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII] how may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I was just calling to get benefits and eligibility for a patient's plan.
[AGENT][NEUTRAL] OK, I can help you with benefits and eligibility eligibility, [PII], um, can I get your call back number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and then what's the patient's name?
[CUSTOMER][NEUTRAL] yeah
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what's Irma's date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And Irma's policy number, please.
[CUSTOMER][NEUTRAL] 01950971 M as in Mary L as in llama 8.
[AGENT][NEUTRAL] OK, let me pull that policy in for us real quick.
[CUSTOMER][POSITIVE] OK thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, I do show that Irma does have an active policy. Her effective date is [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] That's not gonna hurt you.
[AGENT][NEUTRAL] And this is just to verify her coverage it's not a guarantee of payment, she has a supplemental policy that is billed secondary to the primary.
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] It helps with deductible, co-pay, and co-insurance.
[AGENT][NEUTRAL] She has an inpatient calendar year benefit amount of $1500 and then she also has an outpatient calendar year benefit amount of $1500 to go towards the deductible copay or co-insurance.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You said that was 1500 allowance for outpatient?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And then um would we have to be in network with this insurance? Are you able to check our participation?
[AGENT][NEUTRAL] Uh, there's not a network because we're not the primary insurance.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] And so what would the benefits be for physical therapy?
[AGENT][NEUTRAL] Let me check on our policy for you real quick.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] That what she said
[AGENT][NEUTRAL] You're welcome. It's gonna be just a second while the computer pulls it up for us so I can look at it.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And that
[CUSTOMER][NEUTRAL] I just
[CUSTOMER][NEGATIVE] Yeah, so bad about you.
[CUSTOMER][NEUTRAL] I know.
[CUSTOMER][NEUTRAL] Maybe
[AGENT][NEGATIVE] I'm sorry, the computer's being a little slow loading.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] But it's coming up.
[CUSTOMER][POSITIVE] OK, no, no worries.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] I just wanna let you know I didn't forget about you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] At least I'm due here on Friday at [PII].
[CUSTOMER][NEUTRAL] This Friday at [PII]. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Not a problem.
[CUSTOMER][NEUTRAL] I was gonna say I did have a [PII] cancel.
[CUSTOMER][POSITIVE] OK, you're welcome, you too.
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So, physical therapy is actually covered on her policy um in an office, center or clinic in which a licensed physical therapist provides physical therapy. It's based on what her deductible co-pay or co-insurance is. So, um,
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] She has that um outpatient benefit amount of, let me check it again.
[AGENT][NEUTRAL] Of $1500 up to $1500 for deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK, so like she has a $65 co-pay with her Blue Cross Blue Shield, so you guys would pick up the $65 until she used the full $1500 allowance if that was the case.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct. Correct.
[CUSTOMER][NEUTRAL] OK, so then patient has no responsibility then.
[AGENT][NEUTRAL] We don't give patient responsibility just because that's normally determined by the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, but I just want, but you guys do pay 100% of her co-pay?
[AGENT][NEUTRAL] Yes, or co-pay, co-insurance, or deductible, up to 1500 for the physical therapy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Ms. [PII], what is the name of your facility?
[CUSTOMER][NEUTRAL] Uh, facility is physical therapy or I'm sorry, like what do you mean by that?
[AGENT][NEUTRAL] The name of your office?
[CUSTOMER][NEUTRAL] The first rehab physical therapy?
[AGENT][POSITIVE] First rehab. OK, thank you.
[CUSTOMER][NEUTRAL] And then may I just have a reference number for our call?
[AGENT][NEUTRAL] Yes ma'am, you can use my name. It's [PII] and today's date.
[CUSTOMER][NEUTRAL] And then what is your um claims mailing address?
[AGENT][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that is in [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] And then I'm sorry, what was the zip code?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Is there a group number to this plan?
[AGENT][POSITIVE] Yes ma'am, let me get that to you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It is 2430.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I'm sorry, your phone cut out. What was that?
[AGENT][NEUTRAL] I'm sorry, it's 24,430.
[CUSTOMER][NEUTRAL] 24,430.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Great thank you so much [PII] have a great day.
[AGENT][POSITIVE] You too [PII], you have a good rest of your week and thanks for calling APL.
[AGENT][NEUTRAL] Bye bye.