AccountId: 011433970860
ContactId: eb47f79c-1fcd-49ad-bda4-caa8058f07be
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 323140 ms
Total Talk Time (AGENT): 160437 ms
Total Talk Time (CUSTOMER): 141406 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/eb47f79c-1fcd-49ad-bda4-caa8058f07be_20250217T13:35_UTC.wav
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[AGENT][NEUTRAL] Contacting APL, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Is this for the medical benefits line?
[AGENT][NEUTRAL] Yes, I can certainly help you with, with one of our policies, our medical policies. With whom am I speaking, please?
[CUSTOMER][NEUTRAL] Uh, you're speaking to [PII]. Um, I'm calling from Carolina Sports Care and Physical Therapy regarding benefits on a patient.
[AGENT][NEUTRAL] I can help with that. Uh, what's the policy number, please?
[CUSTOMER][NEUTRAL] Yes, it is 02592443.
[AGENT][NEUTRAL] 443 thank you and the patient's name and date of birth please?
[CUSTOMER][NEUTRAL] It is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] I do appreciate that. Thank you very much. And is there a callback number that I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Sure, it is [PII].
[AGENT][NEUTRAL] Thank you very much. First of all, the policy went into effect on [PII]. It is active. Now, you're calling about uh physical therapy benefits. Does that sound correct?
[CUSTOMER][NEUTRAL] Yes, look like this is a, um, it would be in coordination of the primary.
[AGENT][NEUTRAL] That's right, yes, we are a secondary or gap insurance meant to pick up the deductible, co-payment or co-insurance for just the sort of event that you're talking about. So, um, what we will do is we will pick up the deductible, co-payment or co-insurance, uh, for, um, those services up to $4200 calendar year. That's just a verification of the benefits, not a guarantee of payment. Um, physical therapy is uh covered under the policy. Um, I don't, um, I'm just checking here.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, I don't show that, uh, anything. [PII] is using any of the benefits, so it's all available. And so what you'll do, [PII], is you'll, you'll file through their major medical first and then through us.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, now, um, I had what's your name?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] And what's your initials to your last name, please?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, and mine is [PII]. Alright, and this is a calendar year policy?
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][NEUTRAL] OK. And then also, um, you said that they do pick up um deductible and coinsurance, but um do you have the accumulators for the deductible and out of pocket?
[AGENT][NEUTRAL] There is, uh, there is a deductible of $1500 per calendar year, uh, but that's, um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But that's, as I mentioned before, it doesn't look like they've used any of that, those benefits.
[CUSTOMER][NEUTRAL] OK, yeah, the claims are still, I mean, you know, it has been submitted to the primary. The primary had has applied some to it. It's just, uh, uh, it's just a secondary thing I guess submitted. So since you haven't, um, received that 0 has applied toward that.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes, uh, it, it doesn't look like I've received the claim yet and so nothing has been used yet.
[AGENT][NEUTRAL] Um, but
[CUSTOMER][NEUTRAL] OK, um, the last rep, rep I talked to, she said that there was a 4200, um, out of pocket. Um, is that still standing?
[AGENT][NEUTRAL] Well, the, the, um,
[AGENT][NEUTRAL] The, the maximum benefits.
[AGENT][NEUTRAL] The maximum benefits, uh, are, yeah, there's, it's $4200. Now, there is a, um, uh, what we'll do is we have benefits up to $4200 per calendar year with a deductible of $1500. Um, again, just a verification, not a guarantee of payment, but the, but it's the benefits themselves, it's it's the $4200.
[CUSTOMER][NEUTRAL] Oh, the
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So we'll pay up to that amount if that makes sense.
[CUSTOMER][NEUTRAL] OK, so, um, after the 1500 is met, then they'll pay up to 100% up to the 4200?
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, and.
[CUSTOMER][NEUTRAL] Alright, that's all I needed to know, just one moment.
[CUSTOMER][NEUTRAL] And then also too, if, um if primary doesn't cover, um you will follow suit, right?
[AGENT][NEUTRAL] That's correct, yes, the, the whole, um, what we will do is if uh the primary uh has a deductible, co-payment or co-insurance, that's where we come in. Um, if they uh don't, you know, if you're out of network or anything like that with the, with the major medical, uh, then, um, you know, we don't, we don't pay. So we've got to have that deductible, co-payment or co-insurance from the major medical in order to be uh used.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, got it.
[CUSTOMER][NEUTRAL] All right, I think I got the just of it. And so once they maxed out on the 4200, then it's solely the primary benefit, right?
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][NEUTRAL] OK. All right, thank you and then um you have a reference number for this call?
[AGENT][NEUTRAL] Yes, my name is [PII]. The first letter of my last name is [PII].
[AGENT][NEUTRAL] And we're gonna use that in today's date as a reference. Is there anything else at all that I may help with?
[CUSTOMER][NEUTRAL] Uh, that's it.
[AGENT][POSITIVE] OK, well thank you for contacting ATL I hope you have a very good day.