AccountId: 011433970860
ContactId: ea9b3b67-0248-4a5c-bcba-c00d9d048036
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 267239 ms
Total Talk Time (AGENT): 152599 ms
Total Talk Time (CUSTOMER): 93178 ms
Interruptions: 1
Overall Sentiment: AGENT=1.7, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/ea9b3b67-0248-4a5c-bcba-c00d9d048036_20250425T15:17_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from facility to verify benefits for physical therapy.
[AGENT][POSITIVE] OK, I'll be glad to help you, [PII]. Go ahead and give me a good policy number.
[CUSTOMER][NEUTRAL] Policy number 020 I'm sorry, 02605808.
[AGENT][POSITIVE] Alrighty, thank you so much.
[CUSTOMER][NEUTRAL] And can you spell your name for me?
[AGENT][NEUTRAL] Yes, ma'am. [PII], I can. My name is spelled [PII] yes, and go ahead and give me a good return telephone card number, please, ma'am.
[CUSTOMER][NEUTRAL] Um, yes, it's [PII], [PII].
[AGENT][NEUTRAL] Alrighty, thank you for all of that information. Now [PII], go ahead and give me your patient's name and date of birth today.
[CUSTOMER][NEUTRAL] Uh, [PII], [PII].
[AGENT][NEUTRAL] All right, thank you for all that information, [PII]. It looks like [PII] is the insured on this medical supplemental plan. I do show the original effective date is [PII]. Patient is current and active, but I must advise that verification of coverage is not a guarantee of payment on a claim, but you did say you want physical therapy benefits. Is that correct, [PII]?
[CUSTOMER][NEUTRAL] Yes, um, this is secondary to Medicare. She has Medicare AMBS primary.
[CUSTOMER][NEUTRAL] Well, Aetna Medicare.
[AGENT][NEUTRAL] OK, well,
[AGENT][NEUTRAL] OK, well, we do not coordinate with Medicare at all. We only coordinate with a major medical insurance carrier.
[CUSTOMER][NEUTRAL] Oh, never mind. I'm sorry. It's in a commercial plan.
[AGENT][NEUTRAL] OK, yes, ma'am. OK. Yeah, because she would have to, right, she would have to have, yeah, some other coverage besides Medicare. We don't, we don't coordinate with Medicare here at all. OK, let's see, [PII], now, because what we are, yes, ma'am, is her medical supplemental plan. So the only thing that we would pick up and pay on is for sickness and
[CUSTOMER][NEUTRAL] Yeah, my previous, my previousmission was Medicare.
[CUSTOMER][NEGATIVE] No, this is commercial.
[AGENT][NEUTRAL] that is applied towards her deductible copay or co-insurance at her primary insurance carrier. What we would pick up is a, I mean her outpatient benefits for physical therapy is a zero deductible, no pre-cert, and she has a $500 per calendar day benefit.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] $500?
[AGENT][NEUTRAL] $500 per calendar day benefit for physical therapy.
[CUSTOMER][NEUTRAL] OK. Um, we have to submit to Aetna and then the remaining.
[CUSTOMER][NEUTRAL] Amount gonna be covered through this supplemental?
[AGENT][NEUTRAL] Yeah, it has to be applied towards her, right, it has to be applied towards your deductible copay or co-insurance and if it's not covered at a primary, it's not covered here.
[CUSTOMER][NEUTRAL] Up to 500.
[CUSTOMER][NEUTRAL] OK. Um, you guys follow the insurance primary care guidelines?
[AGENT][NEUTRAL] Well, no, ma'am, but if it's not covered there, it's not gonna be covered here because it has to apply towards her deductible copay or co-insurance at her primary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And how much is the deductible?
[AGENT][NEUTRAL] Uh, I'm not sure. You would have to contact the patient about her primary benefits. I can just tell you what the APL benefits is.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What?
[CUSTOMER][NEUTRAL] No, got it. The secondary, they just took the or co-pay or deductible.
[AGENT][NEUTRAL] Right, yes, ma'am. Mhm.
[CUSTOMER][NEUTRAL] Or the coinsurance from the primary. OK. And authorization is not required, and they have 500 per per call date benefit for physical therapy.
[AGENT][POSITIVE] Yes, ma'am. Is there anything else I can help answer for you today, [PII]?
[CUSTOMER][NEUTRAL] Just the reference number for this call.
[AGENT][NEUTRAL] Well, we don't give reference numbers, [PII], but you can use my name in today's date if you need to do so, OK?
[CUSTOMER][NEUTRAL] Um, yes, I will say [PII] for your last name.
[AGENT][NEUTRAL] My last name initial is [PII]
[CUSTOMER][POSITIVE] Thank you. Have a good day and have a nice weekend.
[AGENT][POSITIVE] You as well, [PII]. Thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.