AccountId: 011433970860
ContactId: ec81111e-82d2-4717-bb64-c699b1923a1d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 338820 ms
Total Talk Time (AGENT): 139735 ms
Total Talk Time (CUSTOMER): 160021 ms
Interruptions: 7
Overall Sentiment: AGENT=0.9, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/ec81111e-82d2-4717-bb64-c699b1923a1d_20250217T19:16_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Thank you for calling ATO. This is [PII].
[CUSTOMER][NEUTRAL] Hello, good afternoon. This is [PII] calling from Atlantic Rehabilitation Center, and I'm calling in regards of eligibility and benefits for physical therapy outpatient in the office setting.
[AGENT][POSITIVE] Sure, OK, yeah, I could check those benefits for you, [PII]. uh, can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah, it will be [PII].
[AGENT][NEUTRAL] Thank you, do you have the policy number?
[CUSTOMER][NEUTRAL] Yeah, um, it will be 02489437.
[AGENT][POSITIVE] Alright thank you one moment.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Alright, and what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah, it will be [PII].
[CUSTOMER][NEUTRAL] And the date of birth will be [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that, [PII]. So this policy is active. Effective date was [PII], and as this is a secondary medical policy, it is designed to help with co-pay, deductible and co-insurance after major medical pays. And give me just a moment, let me make sure they have physical therapy benefits under this policy.
[CUSTOMER][POSITIVE] Perfect, thank you for verifying that.
[CUSTOMER][POSITIVE] OK thank you.
[CUSTOMER][POSITIVE] OK, no problem.
[AGENT][NEUTRAL] OK, I appreciate your patience and of course I will let you know verification of coverage is not a guarantee of payment for claims, so physical therapy performed in a physical therapy facility is covered under their outpatient benefit. Their outpatient benefit is on a per calendar day basis, so it would pay up to $500 per calendar day.
[CUSTOMER][NEUTRAL] your
[CUSTOMER][NEUTRAL] know
[CUSTOMER][NEUTRAL] And can you
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So it
[CUSTOMER][NEUTRAL] OK, and how would that work, the $500 per calendar day.
[AGENT][NEUTRAL] That's correct, that's the total benefit amount payable uh under their outpatient benefit.
[AGENT][NEUTRAL] So a maximum of $500 per calendar day.
[CUSTOMER][NEUTRAL] OK, OK, so like if the claims come every day under less than $500 for example, they will be covered. OK, got it, OK, yeah.
[AGENT][NEUTRAL] Right, it would just pay up to that 500 per day.
[AGENT][NEUTRAL] Alright, was there anything else I could help you with?
[CUSTOMER][POSITIVE] Yeah, uh, I also have another member that has um APO if you could help me out too.
[AGENT][NEUTRAL] Uh, sure, give me just a moment, I'll let you know when I'm ready for that.
[CUSTOMER][NEUTRAL] OK, uh sure.
[CUSTOMER][POSITIVE] OK, no problem, thank you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And this was the same we were just looking at the physical therapy benefit for this next one as well?
[AGENT][POSITIVE] OK, alright, I'm ready for that next policy number.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] It will be 01569861 M as in Mary, L as in Lima 8.
[AGENT][NEUTRAL] Thank you and then what was the name and date of birth for this number?
[CUSTOMER][NEUTRAL] And then what was the
[CUSTOMER][NEUTRAL] Yeah, it'll be [PII] and the date of birth is [PII].
[AGENT][POSITIVE] All right, thank you for that. Bear with me just a moment. Let me take a look at this one.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so this one also uh has physical therapy performed in a physical therapy facility covered under their outpatient benefit. Now their outpatient benefit is on a per calendar year basis, so it is $2500 max per calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If you'll give me one moment I'll see if any of that has been used.
[CUSTOMER][NEUTRAL] one
[CUSTOMER][NEUTRAL] OK, got it.
[AGENT][NEUTRAL] OK, none has been used so far this year.
[CUSTOMER][NEUTRAL] OK, and that will cover any copays, deductibles, and co-insurance, right?
[AGENT][NEUTRAL] Right after major medical pays, yes.
[CUSTOMER][NEUTRAL] OK, yeah, and I think, uh, what will be the effective date for that plan?
[AGENT][NEUTRAL] Oh yeah, sorry about that. Give me just a moment. This one's effective date was [PII].
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] OK, got it, and yeah, if you can provide me your name one more time, ma'am.
[AGENT][NEUTRAL] Sure, it's [PII]
[CUSTOMER][NEUTRAL] A.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And initial to your last name?
[AGENT][NEUTRAL] It's A
[CUSTOMER][NEUTRAL] OK, and what would be the reference number for this call?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date. Was there anything else I could help you with tonight?
[CUSTOMER][POSITIVE] No, that will be it. Thank you so much for helping here.
[AGENT][POSITIVE] OK, yeah, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] You too have a good day.
[AGENT][NEUTRAL] You too bye bye.
[CUSTOMER][NEUTRAL] Bye bye.