AccountId: 011433970860
ContactId: db30a39f-732e-4058-90fe-775627566d03
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 317059 ms
Total Talk Time (AGENT): 148684 ms
Total Talk Time (CUSTOMER): 88713 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/db30a39f-732e-4058-90fe-775627566d03_20250423T17:33_UTC.wav
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[AGENT][POSITIVE] Good Afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][POSITIVE] Yes, hi, good afternoon, I'm calling to get benefits and eligibility on a patient.
[AGENT][NEUTRAL] OK, well, I can help you with both the eligibility and the benefits. May I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII] [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number whenever you're ready?
[CUSTOMER][NEUTRAL] 19698.
[AGENT][NEUTRAL] Is that the, the group number or the policy number?
[CUSTOMER][NEUTRAL] That's the number that patient provided.
[AGENT][NEUTRAL] Oh, OK. Let me see if this is the group number cause that's too little for a policy. Hold on one moment.
[CUSTOMER][NEUTRAL] I don't have the physical card on hand.
[AGENT][NEUTRAL] OK, what's the member's first and last name?
[CUSTOMER][NEUTRAL] First name is [PII]
[CUSTOMER][NEUTRAL] Last name [PII]
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, so this is him. Thank you so much and then the member's um date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So I am showing that the policy is active and it's been effective since [PII]. And what type of benefits did you want to go over today?
[CUSTOMER][NEUTRAL] Physical therapy.
[AGENT][NEUTRAL] You said physical therapy?
[CUSTOMER][NEUTRAL] Yes, I also have CPT codes. I don't know if you check with the codes or not.
[AGENT][NEUTRAL] No, we don't use the codes. Will it be in a physical therapy facility or in office?
[CUSTOMER][NEUTRAL] Um, it's physical therapy outpatient office setting.
[AGENT][NEUTRAL] So it's in the office?
[CUSTOMER][NEUTRAL] Yes, well, we bill as specialty.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Alright, so the policy will pay up to $7500 per calendar year towards outpatient expenses. Um, hold on one moment, I'm checking two things.
[AGENT][NEUTRAL] So that um that includes physical therapy and a physical therapy facility, but they also have the office treatment rider. So any treatment as long as it's not cosmetic, done in the office could be covered up to that 7500 per year.
[AGENT][NEUTRAL] So whether the cloths come back as an outpatient facility or sorry, a physical therapy facility or in office, there's coverage for both here.
[CUSTOMER][NEUTRAL] OK, so any copays would be covered?
[AGENT][NEUTRAL] We pay towards the copay, deductible and co-insurance of coverage charges after primary. So if a co-pay is required for services, they would need to pay that upfront and then once we receive the claim, we can reimburse them or if there's something still owed to you all as a provider pay you all.
[CUSTOMER][NEUTRAL] OK, so they would have to pay us and then they file a claim with you.
[AGENT][NEUTRAL] No, they don't file a claim with the, well, I mean they can, but the provider should. We're second to their primary insurance. So once you bill,
[AGENT][NEUTRAL] Um, hold on one moment.
[AGENT][NEUTRAL] We have it as United Healthcare. So once United Health Healthcare's um explanation of benefits comes back, then we will be billed.
[CUSTOMER][NEUTRAL] OK, but in when the patient comes in, I don't have to charge them because once we file a claim, then they'll send them to you.
[CUSTOMER][NEUTRAL] To pay the the copays.
[AGENT][NEUTRAL] Um, so the primary is gonna charge the co-pay and then they'll pay it upfront and then once you file the claim with us, we could reimburse or pay you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that's 7500 you said?
[AGENT][NEUTRAL] Yes, ma'am, per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright thank you so much.
[AGENT][POSITIVE] You're very welcome. Was there anything else I could assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Uh, no, just what is your name and a reference number?
[AGENT][NEUTRAL] My name is [PII] The first initial to my last name is [PII], and there's no call reference number, but you can use my name in today's date.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're very welcome and thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.