AccountId: 011433970860
ContactId: f817d018-1bf9-4321-a796-3d548c9b21b7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 434880 ms
Total Talk Time (AGENT): 167722 ms
Total Talk Time (CUSTOMER): 162493 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/03/f817d018-1bf9-4321-a796-3d548c9b21b7_20250403T17:43_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] and I'm calling from a physical therapy office to get benefits for a patient.
[AGENT][NEUTRAL] OK, I can help you with benefits, Ms. [PII]. Can I please get your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Yes, my callback number is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, ma'am. And then what's the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] It's Progressive Physical therapy Center.
[AGENT][NEUTRAL] Thank you, ma'am. And can I please get the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yes, name is [PII]. The date of birth is [PII].
[CUSTOMER][NEUTRAL] And the policy number is 02501823 M as in mom, L as in Lima, 8.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Let me pull up that policy. I do show that [PII] does have an active policy with us. Her effective date is [PII].
[AGENT][NEUTRAL] And this is just to verify her benefits. It's not a guarantee of payment. She has a supplemental policy that helps with deductible, co-pay, and co-insurance.
[AGENT][NEUTRAL] She has an
[AGENT][NEUTRAL] Inpatient calendar year benefit amount of $7900 and then she also has an outpatient calendar year benefit amount of $2500.
[CUSTOMER][NEUTRAL] OK, um, so I wanted to know first of all if we were in network with her plan.
[AGENT][NEUTRAL] There's not a network because this is not the primary insurance.
[CUSTOMER][NEUTRAL] Mm, OK, um, do you guys follow her insurance's guidelines, her not primary guidelines?
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] It's billed secondary to the primary and it helps with deductible co-pay and co-insurance only.
[CUSTOMER][NEUTRAL] OK, and you guys pick up the deductible and copay?
[AGENT][NEUTRAL] Yes, the deductible, co-pay or or co-insurance.
[CUSTOMER][POSITIVE] OK perfect give me just one second please thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hi, how much is the, the gap that she has for an outpatient office?
[AGENT][NEUTRAL] OK, so office visits are not covered under the policy, but a physical therapy facility is.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, it's for physical therapy.
[AGENT][POSITIVE] Yes, ma'am. So the benefit.
[CUSTOMER][NEUTRAL] The thing the place of service is an outpatient office as a specialist.
[AGENT][NEUTRAL] OK, so it will cover the um.
[AGENT][NEUTRAL] Treatment, but not the physician's fee.
[AGENT][NEUTRAL] It it does say in the policy contract that um a covered outpatient facility is a free standing outpatient surgery center hospital.
[CUSTOMER][NEUTRAL] OK. Um, and how much is the, the gap?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEGATIVE] I hate. Hello?
[AGENT][NEUTRAL] Hello, I can hear you.
[CUSTOMER][NEUTRAL] Oh, sorry, I wasn't able to hear you.
[AGENT][NEUTRAL] So the
[AGENT][NEUTRAL] OK, yes, on the policy contract a covered outpatient facility does include a physical therapy facility.
[CUSTOMER][NEUTRAL] OK, so it does.
[CUSTOMER][NEUTRAL] OK. Um, and what is the, the gap amount that the patient has?
[AGENT][NEUTRAL] Uh, she has a calendar year benefit amount of $2500 and this is just to verify coverage it's not a guarantee of payment.
[CUSTOMER][NEUTRAL] Has she used any of that amount?
[AGENT][NEUTRAL] Let me check for you real quick.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] No ma'am, nothing has been used for the year of [PII].
[CUSTOMER][POSITIVE] Perfect and you guys, sorry once again you guys pick up the copay and the deductible.
[AGENT][NEUTRAL] Deductible, co-pay or co-insurance is what this policy covers.
[CUSTOMER][NEUTRAL] So do you pick up the copay that she would have from her first insurance?
[CUSTOMER][NEUTRAL] It's what we're asking.
[AGENT][NEUTRAL] Well, the way that it, it works is the primary insurance sends in their EOB with the claim and depending on what the primary pays is based on what we pay.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, her primary being?
[AGENT][NEUTRAL] I don't have her insurance.
[CUSTOMER][NEUTRAL] You mean her primary insurance? Her primary, oh, OK, alright, OK, I thought it was something else that you met. OK, yeah, because, um, unfortunately, yeah, every a secondary insurance works a different way, so um if we're asking you a lot of questions is because we just want a lot of clarity as to that we're doing it the right way, that's all.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, so the from the primary would be sent in.
[AGENT][NEUTRAL] OK, yes, I understand.
[CUSTOMER][NEUTRAL] OK. Did you get her name? Yes, [PII]. [PII], can I just get a quick reference number for you?
[AGENT][POSITIVE] Great.
[AGENT][NEUTRAL] I can hear you
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] You can hear me?
[AGENT][NEUTRAL] My phone was being a little swirly. Yes, I can hear you. My phone was a little squirrely there for a minute.
[CUSTOMER][NEUTRAL] Oh, OK. If I can just get a reference number.
[AGENT][POSITIVE] Sorry about that.
[AGENT][NEUTRAL] Yes, ma'am. You can use my name [PII] and today's date.
[CUSTOMER][POSITIVE] OK, thank you so much have a good one.
[AGENT][POSITIVE] You're welcome, Ms. [PII]. You have a great day too, and thanks for calling APL.
[CUSTOMER][POSITIVE] You too, thank you.
[AGENT][NEUTRAL] Bye bye.