AccountId: 011433970860
ContactId: cad0839a-dcd4-4055-bdb4-498bec470396
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 398980 ms
Total Talk Time (AGENT): 234928 ms
Total Talk Time (CUSTOMER): 88673 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/cad0839a-dcd4-4055-bdb4-498bec470396_20250203T18:37_UTC.wav
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[AGENT][NEUTRAL] Excuse me, thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, good afternoon. This is [PII] calling from Atlantic Rehabilitation Center, and I'm calling in regards of eligibility and benefits for physical therapy outpatient in the office setting.
[AGENT][POSITIVE] I'm right.
[AGENT][NEUTRAL] OK. So you're needing outpatient benefits for physical therapy done in an office setting. Is that correct, [PII]?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][POSITIVE] Correct, and I also have some CPC codes.
[AGENT][NEUTRAL] OK, I can help you with this. What is your callback number please, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] Yeah, the member uh policy number.
[CUSTOMER][NEUTRAL] That will be 02176906 ML 8.
[AGENT][POSITIVE] OK, thank you. Just give me a couple of moments please to get all the members' information pulled up.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] Is this gonna be for a future data service like.
[CUSTOMER][NEUTRAL] Uh, for today.
[AGENT][NEUTRAL] OK, so first off, any information that I do provide for you would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, give me one second. The patient's name will be [PII].
[CUSTOMER][NEUTRAL] And the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] I got
[CUSTOMER][NEUTRAL] Are you looking?
[AGENT][NEUTRAL] OK, so first off, um, this policy number that you provided for me, [PII], this is an old policy that's no longer active, um, this policy number that you provided for me actually termed.
[AGENT][NEUTRAL] Uh, 51 of 2024, but she does have another policy that is currently active with a different number.
[AGENT][NEUTRAL] So her policy number that you should have now is 0248.
[AGENT][NEUTRAL] 943 7.
[AGENT][NEUTRAL] And it has an effective date of [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this is a supplemental, I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] So the one that I provide.
[CUSTOMER][NEUTRAL] No, I'm sorry, uh, I just wanted to say that the one that I provided you, uh, it was terminated, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, yeah, can you provide me the information?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And so for the benefits, let's see, on this policy.
[AGENT][NEUTRAL] She does have an office treatment right on this at maximum of $500 per covered person per calendar day for covered outpatient services.
[CUSTOMER][NEUTRAL] Um, $5 out of pocket.
[AGENT][NEUTRAL] This is a supplemental policy only we're not a major medical insurance. This policy is designed to help her with her co-pays, deductibles and co-insurance amounts of coverage services. So again, the outpatient benefit maximum is per calendar day.
[AGENT][NEUTRAL] And that max benefit is $500 per calendar day for covered outpatient services with no outpatient deductible per covered person per calendar day.
[AGENT][NEUTRAL] When you all submit the claim to us for review, you will also need to include her primary insurance company's explanation of benefits.
[AGENT][NEUTRAL] As well.
[CUSTOMER][NEUTRAL] Oh, can you explain to me the out of pocket uh they they.
[AGENT][NEUTRAL] There's no out of pocket. This is, this is a supplemental policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the per per calendar uh day, can you explain that really quick?
[AGENT][NEUTRAL] OK, again, this is a supplemental policy to her primary healthcare insurance.
[AGENT][NEUTRAL] This policy only helps with
[AGENT][NEUTRAL] Deductibles, co-pay, or co-insurance amounts of covered services.
[AGENT][NEUTRAL] So that is why you have to submit the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] Along with the claim for our review.
[CUSTOMER][NEUTRAL] No
[AGENT][POSITIVE] And the maximum benefit.
[AGENT][NEUTRAL] On this policy.
[AGENT][NEUTRAL] It's $500 per covered person per calendar day for covered outpatient services.
[AGENT][NEUTRAL] That is the maximum that this plan will pay per calendar day for covered services.
[CUSTOMER][NEUTRAL] Oh, OK, got it. OK, and yeah, there's no, uh, limit, right? uh, in regards to it, it's just a supplemental plan.
[AGENT][NEUTRAL] $500 is the maximum on any calendar day for any coverage service that this policy would pay towards the deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEGATIVE] And if anything is not covered at all by her primary, it would not be covered by this policy either.
[CUSTOMER][POSITIVE] OK, no problem.
[CUSTOMER][NEUTRAL] OK, got it.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And what would be your name one more time, ma'am?
[AGENT][NEUTRAL] [PII], and you would use my name along with today's date if you need a call reference number.
[CUSTOMER][POSITIVE] OK, thank you so much for helping.
[AGENT][POSITIVE] You are certainly very welcome. And can I help you with anything else?
[CUSTOMER][NEUTRAL] No, that would be it.
[AGENT][NEUTRAL] And then one last thing that you might is if you all file a claim with us once we process our claim we do have a portal that you should be able to go to and check claim status and print out the EOB or APL and our portal website is secured.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, got it.
[AGENT][POSITIVE] OK, well then thank you again for calling APL and I hope you have a great afternoon.
[CUSTOMER][NEUTRAL] I think
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you. Bye-bye. You too.
[CUSTOMER][POSITIVE] Have a good one.