AccountId: 011433970860
ContactId: f5dfaa28-4659-4beb-b96f-bbe6fc89412d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 409779 ms
Total Talk Time (AGENT): 151243 ms
Total Talk Time (CUSTOMER): 164263 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/03/f5dfaa28-4659-4beb-b96f-bbe6fc89412d_20250303T14:50_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, hi, [PII]. Good morning. Uh, my name is [PII]. I'd got to verify benefits, please.
[AGENT][NEUTRAL] OK, um, benefits, OK, I can help with that, [PII]. What is your callback number if we are disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] Thank you. What is your policy number, please, [PII]?
[CUSTOMER][NEUTRAL] It's 01823110, M for Mike, L for Lima, number 8.
[AGENT][POSITIVE] OK, thank you very much for that information, give me one moment please.
[AGENT][NEUTRAL] And to repeat and confirm, I have that as 01823110 ML8.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Thank you verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yes, it's [PII], [PII].
[AGENT][POSITIVE] OK, thank you very much for the information, [PII] and you're calling for eligibility and benefits for this member?
[CUSTOMER][NEUTRAL] Yes, ma'am. I would like to know if this policies have cover for physical therapy or we done in the office, please.
[AGENT][NEUTRAL] OK, physical therapy benefits, one moment please.
[AGENT][NEUTRAL] OK, this plan has no network of providers. We are a supplemental to his major medical.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Give me one moment to check for physical therapy benefits.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Um, please note verification of benefits provided does not guarantee payment. We pay on a per day max of up to $500 for covered services. Again, it pays on a per day max of up to $500.
[CUSTOMER][NEUTRAL] OK, OK. OK, give me a second. Uh, OK, what is the maximum, uh,
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That this patient has for this policy, you're the supplemental or a captain, right?
[AGENT][NEUTRAL] Yes, we are supplemental gap plan and the benefits pay on a per day max. We pay up to $500 max per day, per calendar day.
[CUSTOMER][NEUTRAL] Uh, OK, per visit, for physical therapy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] $500.
[CUSTOMER][NEUTRAL] Is there any
[CUSTOMER][NEUTRAL] The dollar max amount.
[CUSTOMER][NEUTRAL] For this, uh, not for, not for a visit. I mean, the plan. Is there any dollar maximum for physical therapy?
[AGENT][NEUTRAL] For outpatient services, which physical therapy falls under, the max we will pay per day is $500.
[CUSTOMER][NEUTRAL] Yeah, no, OK. So, you only would pay per, per day, not per plan, right?
[AGENT][NEUTRAL] Per day, that is correct, per calendar day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, give me a second.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] For the secondary insurance, right? OK. It's for for chiropractic, not in the office.
[CUSTOMER][NEUTRAL] Uh, is there any difference?
[CUSTOMER][NEUTRAL] Is Glover
[AGENT][NEUTRAL] No, it the max the max will be $500 per day. If this member went to the ER, we only pay $500 per day. If the member went to the ER and didn't chiropractic, the max we'll pay per day for like for today will be $500.
[CUSTOMER][NEUTRAL] OK. It will be the same for chiro and for chiropractic and for physical therapy, it will be the same, $500 only per day, right?
[AGENT][NEUTRAL] For coverage services.
[AGENT][NEUTRAL] Yes, $500 per calendar day is the max that we will pay for covered benefits.
[CUSTOMER][NEUTRAL] OK. There is no deductible, there's no coinsurance.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. What is the nation there for this policy?
[AGENT][NEUTRAL] I'm sorry, the effective date?
[CUSTOMER][NEUTRAL] Yeah, and determination day.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] The excuse me, the plan is currently active, so there's no termination date, but the effective date shows [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, I think the, the plan revenue every, every [PII] for every year, right?
[AGENT][NEUTRAL] This is a calendar year policy.
[CUSTOMER][NEUTRAL] It will be revenue on [PII], right?
[AGENT][NEUTRAL] It's a calendar year policy, so [PII].
[AGENT][NEUTRAL] The calendar year policy.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh, OK, so, because the primary insurance has a termination, they put, um, generally.
[CUSTOMER][NEUTRAL] No, it will be uh this termination date for the primary insurance is on [PII]. That's why I asked. OK, give me a sec.
[AGENT][NEUTRAL] And of course if the member does not have a major medical at the time of service, then of course we will not pay because we're a secondary or a gap insurance.
[CUSTOMER][NEUTRAL] OK, I understand. Where that we have to send the
[CUSTOMER][NEUTRAL] The claim, do you have any payer ID or, or fax number?
[AGENT][NEUTRAL] The claims?
[AGENT][NEUTRAL] We have both, yes, and the billing address as well. Our fax number is, I'm sorry, our payer ID is 60801.
[CUSTOMER][NEUTRAL] OK. And the fax number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, OK, give me a second. I'll try to, to write it down. OK, give me a second.
[CUSTOMER][NEUTRAL] Oh my [PII].
[CUSTOMER][POSITIVE] Yes please.
[CUSTOMER][NEUTRAL] Can you repeat for me, what is the fax number?
[AGENT][NEUTRAL] OK. [PII].
[CUSTOMER][NEUTRAL] [PII]. OK, just looking for 8773659423.
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] Oh, what is the reference number for this card and just
[AGENT][NEUTRAL] We do not use reference numbers, [PII], but you can use my name in today's date. My last initial is [PII]. Um, anything else I can help you with [PII]?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] That's all on my own. Thank you and you for your patience.
[AGENT][POSITIVE] You're welcome, [PII], and thank you for calling APL. You have a great week.
[CUSTOMER][POSITIVE] Bye. Thank you.