AccountId: 011433970860
ContactId: e788ace6-60a4-4c99-96a8-093b97d6e50e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 414649 ms
Total Talk Time (AGENT): 153099 ms
Total Talk Time (CUSTOMER): 118242 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/e788ace6-60a4-4c99-96a8-093b97d6e50e_20250227T13:44_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good morning thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Uh hi, this is [PII]. I'm calling on behalf of provider's office to check on members' eligibility and benefits for physical therapy.
[AGENT][NEUTRAL] OK, you said your name was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And do you have a phone number I can get in case we get disconnected, I can call you back.
[CUSTOMER][NEUTRAL] [PII] and it's a direct line.
[AGENT][NEUTRAL] OK, I didn't understand. Can you give it to me one more time?
[CUSTOMER][NEUTRAL] Yes. [PII] and it is a direct line.
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] The policy number is 2506578.
[AGENT][NEUTRAL] Thank you, [PII]. Hold on one moment, please.
[CUSTOMER][NEUTRAL] Yeah, ma'am, sure.
[AGENT][NEUTRAL] And what's the patient's name?
[CUSTOMER][NEUTRAL] OK. The patient's name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you, [PII] and you were just needing benefits for physical therapy?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on just a moment. I can help you with that.
[AGENT][NEUTRAL] This policy canceled 71 to 24. Hold on one moment, let me see if they have another policy, OK?
[CUSTOMER][NEUTRAL] And also could you please confirm me the network status, ma'am, whether we are in network or out of network with this member's plan.
[AGENT][NEUTRAL] This policy does not have a network.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] OK, they do have another policy. That policy number is
[AGENT][NEUTRAL] 01
[AGENT][NEUTRAL] 40
[AGENT][NEUTRAL] 252 6
[CUSTOMER][NEUTRAL] 0147. Can you please repeat again, ma'am?
[AGENT][NEUTRAL] 01.
[AGENT][NEUTRAL] 40.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 252 6
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] OK, this is the primary insurance, right?
[AGENT][NEUTRAL] No, this is a secondary policy.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] American Public Life is the primary insurance, correct?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] American public life is secondary.
[CUSTOMER][POSITIVE] OK, thank you, ma'am.
[AGENT][NEUTRAL] The effective date is [PII].
[AGENT][NEUTRAL] Any benefits given over the phone is not a guarantee of payment?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] This policy uh coordinates with the primary insurance?
[AGENT][NEUTRAL] Whatever the primary applies to the deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And did you say this was for outpatient?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, for outpatient, it'll pay up to
[AGENT][NEUTRAL] 1250.
[AGENT][NEUTRAL] Per calendar year.
[CUSTOMER][NEUTRAL] This is the deductible amount, right?
[AGENT][NEUTRAL] No, they have no deductible. This is the calendar year maximum for outpatient benefits 1250.
[CUSTOMER][NEUTRAL] And what is the accumulation?
[AGENT][NEUTRAL] Hold on just a moment, I'll check for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] She has not used anything for this year.
[CUSTOMER][NEUTRAL] OK. And there is no deductible, no coinsurance, and is there any auto, sorry, copy for this number?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][POSITIVE] Thank you so much. And also, could you please confirm me, is there any visit limits?
[AGENT][NEUTRAL] No, ma'am, it just has a maximum.
[CUSTOMER][NEUTRAL] It's based on medical City, right?
[AGENT][NEUTRAL] It coordinates with the primary insurance.
[CUSTOMER][NEUTRAL] OK, and what about authorization is authorization is required for this number?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] And referral PCP referral.
[AGENT][NEUTRAL] I didn't, I couldn't understand your question.
[CUSTOMER][NEUTRAL] Prior authorization is not required and what about referral, ma'am, PCP referral?
[AGENT][NEUTRAL] It is not required.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And also can you please help me with the plan name?
[AGENT][NEUTRAL] Meddling
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Midlink.
[CUSTOMER][NEUTRAL] I did
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And also, can you please help me with the plan type?
[AGENT][NEUTRAL] Med Link, [PII]
[CUSTOMER][NEUTRAL] Thank you. And also, can you please help me the claim's mailing address and the pay ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 248,950
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 73124.
[CUSTOMER][NEUTRAL] Payer I
[AGENT][NEUTRAL] I just gave it to you. 60801.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much. And also, can you please spell your name?
[AGENT][NEUTRAL] [PII] We do not have reference numbers. You can use my name and today's date.
[CUSTOMER][POSITIVE] Thank you so much, [PII], for assisting me today. Have a pleasant day. bye. Take care.
[AGENT][POSITIVE] Thank, thank you, [PII], for calling APLU as well. Bye-bye.