AccountId: 011433970860
ContactId: dcee01df-f57a-4479-8d41-834ed6dadfdf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 345730 ms
Total Talk Time (AGENT): 161487 ms
Total Talk Time (CUSTOMER): 109249 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/28/dcee01df-f57a-4479-8d41-834ed6dadfdf_20250128T17:36_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] speaking. How may I help you?
[CUSTOMER][NEUTRAL] Uh, hi, I want to confirm if this um member have um physical therapy benefits with this insurance.
[AGENT][POSITIVE] OK, I can help you with uh benefits. Can I have your name please?
[CUSTOMER][NEUTRAL] Mhm. [PII] Last name initial is [PII].
[AGENT][NEUTRAL] Thank you [PII]. Can you tell me uh where you're calling from today? Name of the facility?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And yes, NYU Langham Orthopedic Hospital.
[CUSTOMER][NEUTRAL] The address is [PII] is the zip code.
[AGENT][POSITIVE] Thank you [PII], can I have a callback number in case we get disconnected please?
[CUSTOMER][NEUTRAL] [PII], that's a direct line.
[AGENT][NEUTRAL] Thank you and what's the policy certificate or member ID number please?
[CUSTOMER][NEUTRAL] I have a 02405750.
[AGENT][POSITIVE] OK, thank you [PII] give me just one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can I please have you verify patient's name and date of birth?
[CUSTOMER][NEUTRAL] I have a Wheeler Ramsey, [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And just give me one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and it looks like I do have an updated policy number for you, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me just check some information.
[AGENT][NEUTRAL] And I'll give you those benefits you said it was outpatient physical therapy, is that right?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, just to let you know it is a verification of coverage only, not a guarantee of payment. Um, that policy number it's effective date is [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that's gonna be 0252.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 1580.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And again that effective dates [PII]. Now this policy is a supplemental limited benefit expense plan, so we are secondary to the major medical.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And just give me one moment for those outpatient benefits.
[AGENT][NEUTRAL] Now, um, will this be outpatient hospital or are you a free, uh, a physical therapy facility?
[CUSTOMER][NEUTRAL] Outpatient hospital.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Because I believe under their outpatient benefit plan it does need to be a physical therapy facility in order to be covered under this plan, um, it is.
[CUSTOMER][NEUTRAL] Oh, we bill for facility.
[AGENT][NEUTRAL] OK, so, um, I'll go ahead and, and give you those benefits for that outpatient services. Um, it is an outpatient maximum of $2000 and that's per covered person per calendar year.
[AGENT][NEUTRAL] And that's for services covered under the plan?
[AGENT][NEUTRAL] So this policy will work hand in hand with their major medical to cover co-insurance and deductible amounts up to that $2000 for covered services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And um I think I'm OK. I just wanna make sure that this is active. And you said um updated insurance ID it's now 925.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, 21,580.
[AGENT][NEUTRAL] No, it's 0 and let me repeat that. That's the uh I think you heard me wrong uh that policy number is 02.
[AGENT][NEUTRAL] 52.
[AGENT][NEUTRAL] 1580.
[CUSTOMER][NEUTRAL] That's what I have. That's the member ID number, correct?
[AGENT][NEUTRAL] Yes, 02521580 effective [PII].
[CUSTOMER][NEUTRAL] [PII]. Let me just put it down once again. Thanks for that.
[AGENT][NEUTRAL] Did you have any additional questions, [PII]?
[CUSTOMER][NEUTRAL] Um, I'm ready for the call reference. Let me just get your name first. And uh the name of this insurance, let me just make sure that I have the correct one.
[CUSTOMER][NEUTRAL] It's uh APL, correct?
[AGENT][NEUTRAL] That's correct, APL mhm and do you have our Oklahoma City claims address?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh, let me see.
[CUSTOMER][POSITIVE] Um, yes, [PII]. Perfect. APO.
[AGENT][POSITIVE] Yes, that's correct mhm.
[CUSTOMER][NEUTRAL] And this, and this, it's a secondary as you mentioned, right?
[AGENT][NEUTRAL] Right, so it will require that primary insurance explanation of benefits with any claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, very good. Can you please spell your first name for me?
[AGENT][NEUTRAL] Certainly, so my name and today's date is your call reference number, [PII]. So my first name [PII], last initial [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK. So, [PII], thanks for your assistance today. Have a great day.
[AGENT][POSITIVE] You too, [PII] thank you for calling APL. I hope you have a great rest of your day as well.
[CUSTOMER][NEUTRAL] You too. Bye.
[AGENT][POSITIVE] Thanks. Bye bye.