AccountId: 011433970860
ContactId: e88ff3e4-e626-4e30-992d-25ef5e6c5d47
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 328480 ms
Total Talk Time (AGENT): 155482 ms
Total Talk Time (CUSTOMER): 108997 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/e88ff3e4-e626-4e30-992d-25ef5e6c5d47_20250203T18:30_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi Ms. [PII], I am giving you guys a call. Um, I just called to confirm my member's benefits for physical therapy, but I just wanna make sure that I did jot down the correct information, so I'm calling again.
[AGENT][NEUTRAL] OK, so you're wanting to re-verify benefit information on a member?
[CUSTOMER][NEUTRAL] So right, for physical therapy.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And who am I speaking with?
[CUSTOMER][NEUTRAL] My name is [PII]. Last initial is [PII].
[AGENT][NEUTRAL] Thank you. And what is your callback number, [PII]?
[CUSTOMER][NEUTRAL] [PII] direct line.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Thank you and the member's policy number?
[CUSTOMER][NEUTRAL] Members's policy number is 2180309.
[AGENT][POSITIVE] OK, thank you one moment.
[CUSTOMER][POSITIVE] Mhm, thank you so much.
[AGENT][POSITIVE] You're welcome, you're very welcome.
[AGENT][NEUTRAL] And any information that I provide for you, [PII] will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, patient's name is [PII]. Date of birth [PII].
[AGENT][POSITIVE] OK, thank you
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you don't need eligibility, you're strictly just wanting the benefits, is that correct?
[CUSTOMER][NEUTRAL] Yes, um, I, I got eligibility and benefits already, but just to be on the safe side.
[AGENT][NEUTRAL] OK. And you're needing outpatient benefits for physical therapy, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] She has an outpatient. Now, is this gonna be done at a freestanding facility or in an office?
[CUSTOMER][NEUTRAL] It it'll be done in office.
[AGENT][NEUTRAL] OK. So, on this plan, if there's an office visit charged, that is not covered. She does have an office treatment writer which we can review the treatment under her outpatient benefit maximum, which is $6000.
[AGENT][NEUTRAL] Her covered person per calendar year for covered outpatient services.
[AGENT][NEUTRAL] And [PII], I don't know if they told you when you called before, but because this is a supplemental policy to the primary insurance, we will have to have a copy of the primary insurance company's explanation of benefits as well for review.
[AGENT][NEUTRAL] And then once we have processed our claim, we do have a portal that you can check claim status in by going to secured. [PII].
[CUSTOMER][NEUTRAL] OK dokey, so the patient has a $6000 limit that applies towards any co-pays, deductibles, co-insurance, out of pockets.
[AGENT][NEUTRAL] Of covered services. Mhm.
[CUSTOMER][NEUTRAL] Of cover services, of course, with the primary covers. OK dokey.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] And again, office visits though under this policy are not covered.
[AGENT][NEUTRAL] We can review the treatment, but the office says the charges would not be covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right. Meaning if the patient was to see the doctor here with us. Correct. But the physical therapy would be right, but for physical therapy, we'll have the $6000 living.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Correct. Correct. That's not a covered benefit.
[AGENT][NEUTRAL] We can review the therapy.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh if it would fall under that maximum. Yes, that is her outpatient calendar year maximum benefit for covered outpatient services.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] OK, and once the patient has reached that um $6000 limit, um, is authorization required or the patient would just be responsible for any charges after that?
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] There is no authorization required because we are a supplemental policy, but we also do not determine patient responsibility, that is up to the provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK dokey then well thank you so much for your help and your time. I do appreciate you.
[AGENT][NEUTRAL] Well, you're
[AGENT][POSITIVE] Absolutely, you're certainly welcome. So do you have any other questions or is there anything else for you I can help you with?
[CUSTOMER][NEUTRAL] I just would need your name and a reference number for the call.
[AGENT][NEUTRAL] Uh, again, my name is [PII], and my name in today's date will be your call reference number.
[CUSTOMER][NEUTRAL] OK. And uh uh initial to your last name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Perfect, so then I'll just have [PII] S and that'll be 23 2025.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] Perfect thank you so much Ms. [PII] you have an awesome day.
[AGENT][POSITIVE] You're certainly welcome. Yes ma'am, you too, Bree, and thank you again for calling APL.
[CUSTOMER][NEUTRAL] Mhm bye bye.
[AGENT][NEUTRAL] Bye-bye.