AccountId: 011433970860
ContactId: d77c438b-b931-4c55-a580-2e371113c314
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 335260 ms
Total Talk Time (AGENT): 164486 ms
Total Talk Time (CUSTOMER): 116651 ms
Interruptions: 2
Overall Sentiment: AGENT=0.7, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/07/d77c438b-b931-4c55-a580-2e371113c314_20250207T17:27_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good day, this is [PII] from Bolanis Associates Comprehensive Therapy. I just wanted to ask for eligibility and benefits of one of our patients.
[AGENT][NEUTRAL] OK, and I'm sorry, what is your name?
[CUSTOMER][NEUTRAL] My name is [PII]
[AGENT][NEUTRAL] OK, and you're with a provider's office?
[CUSTOMER][POSITIVE] Yes, that's right.
[AGENT][NEUTRAL] And what's the name of the provider's office?
[CUSTOMER][NEUTRAL] Bolanis Associates.
[AGENT][NEUTRAL] And can you please spell that?
[CUSTOMER][NEUTRAL] Uh, that will be spelled as B as in Bravo, O as in Oscar, L as in Lima, A as in Alpha, NOS.
[AGENT][NEUTRAL] OK, and associates, OK, and what is a good call back number in case we get disconnect and disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you, [PII]. And [PII], what is the policy number that you're calling on?
[CUSTOMER][NEUTRAL] I'm not so sure about the policy number because the card doesn't state one but uh uh it has like an outpatient benefit certification number. Is this the one? Uh, I have it 02.
[AGENT][NEUTRAL] OK. Yes, what is that number?
[CUSTOMER][NEUTRAL] 02473091 ML 8.
[AGENT][NEUTRAL] OK, and what is uh the name of the insured?
[CUSTOMER][NEUTRAL] Uh, it would be [PII].
[AGENT][NEUTRAL] And what is her date of birth?
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And [PII], you're wanting to verify eligibility and benefits?
[CUSTOMER][NEUTRAL] Yes, that's correct, especially for uh physical therapy in network office setting if this is covered.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Physical therapy in a in a physician's office.
[CUSTOMER][NEUTRAL] Yes, in office setting.
[AGENT][POSITIVE] OK, office setting. OK, give me one minute and I'll be happy to check this for you.
[CUSTOMER][POSITIVE] Sure, thank you very much.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And the effective date of coverage is [PII]. The coverage is active.
[AGENT][NEUTRAL] Give me a few more minutes and I'm reviewing uh the benefits.
[CUSTOMER][POSITIVE] Sure, no worries.
[AGENT][NEUTRAL] This policy is a medical supplemental policy. Uh, it picks up the copay, deductible and co-insurance of the primary health insurance company.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, the covered facilities would be a hospital emergency room, urgent care facility, surgery in a hospital outpatient, outpatient facility or free-standing outpatient surgery center.
[AGENT][NEUTRAL] A diagnostic testing in a hospital, outpatient facility, or MRI facility.
[AGENT][NEUTRAL] Um, outpatient treatment for a mental or emotional disorder in a hospital, outpatient facility.
[AGENT][NEUTRAL] It would have to be treatment in a physical therapy facility.
[AGENT][NEUTRAL] Or treatment in an ambulance. Um, if it's coded as an office as a physician's office, then it would not be covered. It would have to be coded as a physical therapy facility.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, mhm.
[CUSTOMER][NEUTRAL] We are a physical therapy facility.
[AGENT][NEUTRAL] OK. Um, I know I cannot guarantee him benefits until we get the claim when it's been reviewed and processed, but, um, you, you need to make sure that it is coded as a physical therapy is the place of service.
[CUSTOMER][NEUTRAL] OK, sure. No worries for that one. So again, this patient is active. And again, I think the patient has a primary and it would be a primary insurance and this insurance would be a supplemental uh it will pick up the coinsurance, right? and co-pay. Is that correct?
[AGENT][NEUTRAL] And deductible, yes.
[CUSTOMER][NEUTRAL] And deductibles, OK, and can I, may I know if there's like a specific limit and if authorization is required? Like is there any visit limit?
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] OK. Um, now, I will tell you this physician cover charges do not include charges for uh durable medical equipment, cancer treatment or physical therapy or physician office visit fee.
[CUSTOMER][NEUTRAL] I'm sorry, what's that again? I, I do apologize.
[AGENT][NEUTRAL] It would not cover physical therapy?
[AGENT][NEUTRAL] Um, fees or physician office visit fee.
[CUSTOMER][NEUTRAL] I'm so, I quite not sure. So does it cover physical therapy facility or just
[AGENT][NEGATIVE] No, it would not cover physical therapy. No, it does not.
[CUSTOMER][NEUTRAL] OK, so the patient has to pay copay for this. OK, thank you. OK, can I have your name and a reference number for this call?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] My
[AGENT][NEUTRAL] My name is [PII], and then you can use today's date. my name and today's date as the reference number.
[CUSTOMER][POSITIVE] OK, thank you very much, [PII]. Have a great day. Bye-bye.
[AGENT][POSITIVE] My pleasure. Is there anything else I can help you out with, [PII]?
[CUSTOMER][NEUTRAL] None so far thank you and have a great day bye bye.
[AGENT][POSITIVE] OK. You're welcome, [PII]. Thank you for calling American Public Life. You have a great day. Goodbye.
[CUSTOMER][NEUTRAL] You too. Bye bye.