AccountId: 011433970860
ContactId: f8e6bdf4-ce6c-475d-85eb-82c0828e129a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 473959 ms
Total Talk Time (AGENT): 162452 ms
Total Talk Time (CUSTOMER): 184344 ms
Interruptions: 5
Overall Sentiment: AGENT=1.3, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/f8e6bdf4-ce6c-475d-85eb-82c0828e129a_20250528T14:56_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, my name is [PII]. I'm calling from Health Advocate. I have a policyholder on the other line. Um, he, we have a copy of his policy. He needs physical therapy, and on the copy of the policy, it states that physical therapy facility, that's how it's stated. I don't know what facility means, um, is covered, and he was told, I guess it wasn't covered, so we're just trying to figure out what's not covered.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Sure, so yes, as long as the the policy does state physical therapy covered in a physical therapy facility, it would be covered under the outpatient benefit. Um, but I can go ahead and get that pulled up and double check. I'm sorry, what was your name?
[CUSTOMER][NEUTRAL] Um, it's [PII], it's [PII]
[AGENT][POSITIVE] OK thank you and then uh can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Um, I don't, but I think he does. Give me one second.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Hello. Hey, we're on the line with [PII]. Do you have your um APL policy number from that card?
[CUSTOMER][NEUTRAL] I do so would that be the in hospital benefits cert number?
[AGENT][NEUTRAL] Yes, that's it.
[CUSTOMER][NEUTRAL] 02 34.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 676 5
[CUSTOMER][NEUTRAL] M as in Mary, L as in Lance, 7.
[AGENT][NEUTRAL] OK perfect thank you and then [PII] just gonna verify some information really quick uh can I get your uh date of birth please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then if you would, can you verify the uh mailing address that we've got on file for you please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Awesome thank you so much for verifying that. OK, give me just a moment, let me get this policy pulled up and we will double check those physical therapy benefits.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] All right. And of course I will let you know verification of coverage is not a guarantee of payment for claims. So yes, under your outpatient benefits, it does state physical therapy performed in a physical therapy facility. So that is covered under outpatient. Give me just a moment. Let me get that information. So your outpatient bed under this policy pays on a per calendar date.
[AGENT][NEUTRAL] Basis that pays up to $500 per calendar day and as this is a secondary medical policy uh that is designed to go towards co-pay, deductible and co-insurance after your major medical pays.
[CUSTOMER][NEUTRAL] Yep, that's exactly what we were seeing on on our end as well. But so like just as for record, I was speaking with the physical therapy location and they, they said they called APL and we're told it's not covered. So is there a way we can maybe call them back to confirm this.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] So yeah, I did
[AGENT][NEUTRAL] Sure I did look um and I don't have any record of uh anyone calling us under this policy so I would verify of course that they do have that correct information but yeah they're more than welcome to speak with us we could clear anything up.
[CUSTOMER][NEUTRAL] So I literally got off the phone with them who was on the line with what I what they said were you guys so is there a way any way we can like reach out to them while on this call to confirm this?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Oh sure, if you are able to add them, that's perfectly fine.
[CUSTOMER][NEUTRAL] Um, OK, I guess I can try to conference them and let me see how that goes.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hello, uh, we should all be on the line here now my physical therapist as well as American Public Life. Hi, how are you? Can you hear me?
[AGENT][NEUTRAL] Hello, how are you?
[AGENT][NEUTRAL] Yes, I can hear you.
[CUSTOMER][NEUTRAL] Hi, who am I speaking with?
[AGENT][NEUTRAL] My name is [PII]. It's [PII]
[CUSTOMER][NEUTRAL] Hi, how are you? I just spoke with uh [PII] last initial T. She stated to me the, uh, they do not cover um the benefits.
[AGENT][NEUTRAL] So I will that again we can verify that all of the information that y'all have is correct, uh, per this member's policy I did get it pulled up and it does state under outpatient benefits that uh physical therapy performed in a physical therapy facility is covered under their outpatient benefits.
[CUSTOMER][NEUTRAL] His for the secondary?
[CUSTOMER][NEUTRAL] And as a matter of fact, could you do it's for occupational, not physical?
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] OK, let's verify that. Give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That might be the hiccup there give me just a moment.
[AGENT][NEUTRAL] OK, yeah, occupational therapy is not going to be covered.
[CUSTOMER][NEUTRAL] OK, yes, it's for his hand.
[AGENT][NEUTRAL] OK. So physical therapy is covered. Occupational therapy is not. Gotcha. OK. That was the confusion.
[CUSTOMER][NEUTRAL] So yes, it's occupational therapy and not physical therapy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Is that OK, [PII]? Yeah, I appreciate you guys uh uh getting me up to date. thank you guys all so much. OK thank you sorry about that OK.
[AGENT][POSITIVE] Absolutely.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] No, no, no, sorry about all the confusion but we got it all squared away.
[CUSTOMER][NEUTRAL] Um, is, is everyone still on the line? I'm, I'm sorry, just by. I'm on the line.
[AGENT][NEUTRAL] Um, no, no, no, you're OK. I am.
[CUSTOMER][NEUTRAL] I'm looking, I'm looking at my prescription and it, it's, it, it doesn't click occupational therapy, it clicks certified hand therapist only.
[CUSTOMER][NEUTRAL] So [PII], the, what I would suggest is speak to whoever ordered it if there's some confusion about that, because bottom line is physical therapy would be a covered benefit, occupational is not. So if they want to bill it as physical therapy or are able to do that, that would be ideal, but that's gonna be up to the provider and the office to build that how they want to.
[AGENT][POSITIVE] Absolutely, yes.
[AGENT][POSITIVE] Absolutely.
[CUSTOMER][POSITIVE] Understood I'll give them a call right away.
[AGENT][NEUTRAL] Alright, y'all have any other questions for me?
[CUSTOMER][NEUTRAL] Alright, I anything from.
[CUSTOMER][POSITIVE] Good for now I'll be giving you a call back if I do. All right [PII] yeah [PII] and we spoke. All right, thank you I appreciate it.
[AGENT][POSITIVE] Absolutely. All right.
[AGENT][POSITIVE] Thank you have a good one bye bye.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] You too. And [PII]