AccountId: 011433970860
ContactId: e736553c-e8a8-497b-9188-7e11d94a24ef
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 264059 ms
Total Talk Time (AGENT): 138066 ms
Total Talk Time (CUSTOMER): 93952 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/30/e736553c-e8a8-497b-9188-7e11d94a24ef_20250430T18:53_UTC.wav
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[AGENT][NEUTRAL] For contacting ATO, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] both.
[CUSTOMER][NEUTRAL] Hi, it's [PII] from Advent Health Orlando to checking on the patient eligibility and benefits.
[AGENT][NEUTRAL] I can help with eligibility and benefits to you. What is the policy number, please?
[CUSTOMER][NEUTRAL] 95.
[CUSTOMER][NEUTRAL] Yeah, the policy number
[AGENT][NEUTRAL] You may begin with the 01 or 02.
[CUSTOMER][NEUTRAL] Uh, no, sir. 0250571919. M as in Mike Lima 8.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Uh, [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The policy went into effect on [PII]. It is active. Now this is a secondary or gap insurance that's meant to pick up the deductible, co-payment or co-insurance from the major medical. You mentioned wanting to know about benefits. Is there anything in particular that I can help with inpatient, outpatient benefits?
[CUSTOMER][NEUTRAL] Yeah, I have the CPT code uh for the benefits when you're ready.
[AGENT][NEUTRAL] Well I don't really need that. I just need to know whether it's outpatient or inpatient services.
[CUSTOMER][NEUTRAL] Yeah for outpatient uh physical therapy.
[AGENT][NEUTRAL] OK. Um, so what, what we will do is we will pick up the deductible, co-payment or co-insurance for physical therapy up to $2500 per calendar year. That's just a verification of the benefits, not a guarantee of the payment.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] And it doesn't look like [PII]'s used any of his benefits at all. So, you would file through uh the major medical first and then through us.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] It does look like that would be covered for major for uh physical therapy.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And did, did you need to know our mailing address or is there anything else I can help with?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Uh, it's fully covered. There is no deductible and out of pocket, it's right.
[AGENT][NEUTRAL] Right, we, what we do is we would pick up the deductible, co-payment or co-insurance from the major medical.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, can I get that? Can I get the deductible and the out of mocking?
[AGENT][NEUTRAL] Well, up to that $2500 yes. And again, that's just a verification, not a guarantee of payment.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] The deductible is 2500. It's fully met.
[AGENT][NEUTRAL] No, no, nothing's been used so far. Right, nothing's been used so far, so all of those benefits will be available.
[CUSTOMER][NEUTRAL] Can I get the accumulation?
[CUSTOMER][NEUTRAL] OK, can get out of pocket?
[AGENT][NEUTRAL] Well, um, so what we'll do is, uh, the out of pocket, OK, um, we will pay that much so that he does, so that, that is his out of pocket expenses, we will pay up to that amount.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] So anything, anything beyond 20 $2500 we would not pay, but we would pay up to that $2500 which again is just a verification, not a guarantee of payment, but that's, that's what we would pay. That's what is out of pocket expenses would be.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And and that's what we would pay.
[CUSTOMER][NEUTRAL] But for yeah.
[CUSTOMER][NEUTRAL] OK. With the 2500, it's out of pockets right?
[AGENT][NEUTRAL] Uh, right.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] There's no deductible. There is any co-insurance or co-pay?
[AGENT][NEGATIVE] Uh, no, not, not with this policy, no.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, that is only out of pocket is 2500. The remaining is 2500, that's right.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Is there anything else I can help with?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mm, the authorization is required for physical therapy.
[AGENT][NEUTRAL] Uh not pre pre-authorization is not required.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I get your name and the last name, [PII]?
[AGENT][NEUTRAL] Yes, my name is [PII]. The first letter of my last name is [PII], and we're gonna use that today's date as a reference.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] OK, thank you, [PII]. Thank you for assisting. Have a great day. Bye for now.
[AGENT][POSITIVE] OK, thanks for contacting ATL. Have a very good day. Thank you.