AccountId: 011433970860
ContactId: cb7bd1b6-bab3-4205-b7f7-72ad07b72b28
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 233699 ms
Total Talk Time (AGENT): 111049 ms
Total Talk Time (CUSTOMER): 109552 ms
Interruptions: 2
Overall Sentiment: AGENT=2, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/cb7bd1b6-bab3-4205-b7f7-72ad07b72b28_20250312T12:28_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. um, I'm calling just to verify um benefits for this patient for physical therapy.
[AGENT][NEUTRAL] OK, [PII], you do not need eligibility. You only need benefit information, is that correct?
[CUSTOMER][NEUTRAL] Um um
[CUSTOMER][NEUTRAL] Um, yeah, this plan should still be active. I just talked with the patient this morning.
[AGENT][NEUTRAL] OK, yes, well, I can help you with both. And [PII], what is your callback number, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and the member's policy number.
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] Outpatient benefit 02296604 M as in Mary, L as in Lima 8.
[AGENT][POSITIVE] OK, thank you one moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] It I mean it's it's not been bad going in the last week was the first time that I was like that.
[CUSTOMER][POSITIVE] I got you OK.
[CUSTOMER][NEUTRAL] O
[CUSTOMER][NEUTRAL] Yeah, I mean I I knew it was.
[AGENT][NEUTRAL] OK, and [PII], any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, patient's name is [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK, thank you. And you said this is gonna be for outpatient physical therapy, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] OK, so her outpatient benefit maximum per calendar year for covered outpatient services is $7900 and there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so that would, um, because I know this is supposed to go with her, um, Aetna plan, would that cover any like Aetna deductibles or co-pays or co-insurances?
[AGENT][NEUTRAL] Again, this policy is designed to help them with their co-pays, deductibles, and co-insurance amounts of coverage services, so we will just have to receive the claim for review and because it is a supplemental policy, [PII], we will also have to have a copy of the primary insurance company's explanation of benefits along with the claim.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then once we have processed our claim we do have a portal that you should be able to check claim status in by going to [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] You got a lot of
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK perfect and then I see the the claims address on the back is the [PII].
[AGENT][NEUTRAL] No ma'am. That's a, let me give you an updated address. That's our old PO box.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK, let me get.
[AGENT][NEGATIVE] And mail is no longer getting forwarded. That's.
[CUSTOMER][NEUTRAL] Oh good to know. Let me get that pulled up. Sorry, give me one second. I did see a different, I did see a different address on the website. Is that the [PII]?
[AGENT][NEUTRAL] No, you're fine, yeah.
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Mhm. [PII] is the zip. OK, perfect. I'm glad that.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK sweet I will tell the billing department thank you so much for confirming that you have a good one.
[AGENT][POSITIVE] Oh, you are so, yes, ma'am, me too. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] That is all.
[AGENT][POSITIVE] OK, well then, thank you again for calling APL and I hope you have a great day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you. Bye-bye.