AccountId: 011433970860
ContactId: ef2e96a1-a2ed-4cd1-a35d-5066a4b0681a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 262640 ms
Total Talk Time (AGENT): 115372 ms
Total Talk Time (CUSTOMER): 87324 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/08/ef2e96a1-a2ed-4cd1-a35d-5066a4b0681a_20250108T20:22_UTC.wav
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[AGENT][NEUTRAL] For calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] [PII], hi, this is [PII] with UTMB in [PII]. I'm trying to verify benefits for one of your members, but I also need to know if we contracted with this plan.
[AGENT][NEUTRAL] OK, is this for service in an office setting?
[CUSTOMER][NEUTRAL] No, this is for um outpatient facility and the patient is coming in for physical therapy.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And what's the policy number, [PII]?
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] The policy number?
[CUSTOMER][NEUTRAL] Yes, that policy number it's going to be.
[CUSTOMER][NEUTRAL] 01653567.
[AGENT][NEUTRAL] Can I get a callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh [PII], that's [PII] Birthday is [PII].
[AGENT][NEUTRAL] Thank you for that information, uh, [PII]. I'm showing the policy effective date is [PII] currently active, and let me pull up the benefits and I can provide that information to you.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So under this policy, um,
[AGENT][NEUTRAL] You said that the physical, the physical therapy is gonna be in a hospital facility, an outpatient facility? OK.
[CUSTOMER][NEUTRAL] Yes, in outpatient facility, yes.
[AGENT][NEUTRAL] Uh, OK, so there is an outpatient benefit under this policy. It's up to $3500 that is per calendar here, and this information is verification only, not a guarantee of payment and let me see what has been used for [PII], if any.
[AGENT][NEUTRAL] OK, so I don't show any of that benefit used at this time for this year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Any other questions?
[CUSTOMER][NEUTRAL] So that's a max of 3500?
[AGENT][NEUTRAL] Per calendar year for any outpatient, not it's not specific to physical therapy, it's any outpatient service.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, I see that the patient also have Blue Cross Blue Shield as a primary, so the plane will automatically transfer to y'all.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEGATIVE] I don't believe so. I don't believe it's an automatic rollover.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, what's your PO box?
[AGENT][NEUTRAL] It's PO Box 2
[CUSTOMER][NEUTRAL] Oh, your claim?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do you want the mailing address or the payer ID? Well, if you're sending the primary, you'll need the PO box.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, yeah, go ahead and give me.
[CUSTOMER][NEUTRAL] Both, I guess.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] The PO box is 248.
[AGENT][NEUTRAL] 950.
[AGENT][NEUTRAL] In [PII].
[AGENT][NEUTRAL] State is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Zip code is [PII].
[AGENT][NEUTRAL] The payer ID number?
[CUSTOMER][NEUTRAL] 7134.
[AGENT][NEUTRAL] 731
[CUSTOMER][NEUTRAL] I'm sorry, the zip code?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And uh dash [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the payer ID?
[AGENT][NEUTRAL] It's 60801.
[CUSTOMER][NEUTRAL] OK, um, so there's no authorization required or limit to the visits or anything like that?
[AGENT][NEUTRAL] It's $1 maximum?
[CUSTOMER][NEUTRAL] Referral requirement.
[AGENT][NEUTRAL] Referral is not required.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And authorization required.
[AGENT][NEUTRAL] Authorization is not required.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Um.
[CUSTOMER][NEUTRAL] And also there's no limit to the visits, correct? The longest.
[AGENT][NEUTRAL] It's not a number, it's based on $1 it's $1 maximum, not a, not a visit maximum.
[CUSTOMER][NEUTRAL] They don't
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK. [PII], and can I have the initial of your last name?
[AGENT][NEUTRAL] Mhm it's [PII] and you'll use my name in today's date as reference for today's call, [PII]. And did you have any other questions?
[CUSTOMER][POSITIVE] No, no, no, that's gonna be all. Thank you so much.
[AGENT][POSITIVE] OK. You're welcome. Thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][NEUTRAL] Um, bye-bye.