AccountId: 011433970860
ContactId: cee0def1-f266-479c-a867-fbeb06cd18ae
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 276130 ms
Total Talk Time (AGENT): 139655 ms
Total Talk Time (CUSTOMER): 86543 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/cee0def1-f266-479c-a867-fbeb06cd18ae_20250415T17:43_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from a provider's office trying to get benefit information for physical therapy.
[AGENT][NEUTRAL] All right, [PII], I'm happy to check on benefits. What's the patient's policy number?
[CUSTOMER][NEUTRAL] 02595525
[AGENT][NEUTRAL] OK, let me take a look here.
[AGENT][NEUTRAL] And then [PII], do you have a good callback number by chance?
[CUSTOMER][NEUTRAL] Yep it's [PII] direct line.
[AGENT][NEUTRAL] Thank you. And then what is the patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you so much. So, patient is active. Uh, the effective date on here is gonna be [PII].
[CUSTOMER][NEUTRAL] And is this for in network or out of network benefits?
[AGENT][NEUTRAL] So, excuse me, there is no network required. It's a limited benefit plan, so it's only gonna pay a set amount depending upon what the patient's being seen for. So, let me pull up what the physical therapy office visit. Let me see here.
[CUSTOMER][NEUTRAL] For the week
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So under the patient's outpatient uh sickness and treatment benefit, uh, physical therapy, they're allowed a maximum of 4 days for the calendar year.
[AGENT][NEUTRAL] And the plan is gonna pay $30 per day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So is that a co-insurance or a co-pay?
[AGENT][NEUTRAL] It's neither. It's the only thing, that's what, that's what the insurance is gonna pay towards the visit. So whatever the physical therapist charges, yeah, for that visit, we're gonna pay that $30 towards it and that's that.
[CUSTOMER][NEUTRAL] Neither
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] 30
[AGENT][NEUTRAL] Cause it's not a major medical.
[CUSTOMER][NEUTRAL] Got you and do they, are they responsible for any deductibles or out of pocket amounts?
[AGENT][NEGATIVE] I don't believe that.
[CUSTOMER][NEUTRAL] Or it's just whatever like the first um.
[AGENT][NEUTRAL] Yeah, there's no deductible or anything like that on the plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and it's a max of 4 visits.
[AGENT][NEUTRAL] Mhm. For the calendar year, correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, and that's for the outpatient benefits correct?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And then let's say they use all 4 of the visits, can they request more? Um, could we request more or it's just a max of 4 for the entire year?
[AGENT][NEUTRAL] Yeah, it's just a max of 4 for the entire year.
[AGENT][NEUTRAL] Since it's a limited benefit plan.
[CUSTOMER][NEUTRAL] And then um are you able to see if this is their primary insurance?
[AGENT][NEUTRAL] No, unfortunately not. We don't have that info.
[AGENT][NEUTRAL] You would have to check with the insured, yeah.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][POSITIVE] OK, OK, not a problem thank you so much for your help. Can I have a reference number?
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] Yeah, no problem, [PII]. Uh reference number is gonna be my name with my last initial and then today's date. My name again is [PII], that's [PII] My initial to my last name is [PII], and then today's date.
[CUSTOMER][NEUTRAL] And then could I, oh sorry to cut you off, or could I have the um.
[CUSTOMER][NEUTRAL] The billing address for claims.
[AGENT][NEUTRAL] Yeah, absolutely. So claims are gonna go to uh attention to IMA.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it's gonna be at [PII].
[AGENT][NEUTRAL] And that's in [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[AGENT][NEUTRAL] And I have a payer ID too if you would like that.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Uh, the payer ID is going to be 64556.
[CUSTOMER][POSITIVE] OK, uh thank you so much for your help.
[AGENT][POSITIVE] You're welcome. Have a good day.