AccountId: 011433970860
ContactId: f90d0ae3-b987-4cb4-801e-fe886f31b9cd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 278160 ms
Total Talk Time (AGENT): 117666 ms
Total Talk Time (CUSTOMER): 111502 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/f90d0ae3-b987-4cb4-801e-fe886f31b9cd_20250312T20:22_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon, [PII]. Can you hear me?
[AGENT][NEUTRAL] Yes, I can hear you.
[CUSTOMER][NEUTRAL] OK, just making sure I'm not talking. Uh, my name is [PII], and I'm calling from nurse on Call. I was calling to see if I can verify a patient's insurance for, um, home health services.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, well, I can definitely help you with the eligibility and the coverage. And [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII], no extension.
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yes, I have 01673440.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, [PII]'s first name is spelled, I don't want to mispronounce it, but it's [PII] Last name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. Um, so I am showing that the policy is active, it's been effective since [PII].
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] And you said you want to look into home health benefits?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] So this policy doesn't have any home health benefits. It's more so inpatient and outpatient um benefits. It's broken down into place of service, um, so there's no coverage for like a home.
[AGENT][NEUTRAL] Health or home aid is more like outpatient facilities, physical therapy, uh.
[AGENT][NEUTRAL] Hospital, outpatient facilities, urgent care, not really at home.
[CUSTOMER][NEUTRAL] OK, um, so even if the patient is receiving physical therapy at home and skilled nursing, it, it wouldn't be covered.
[AGENT][NEUTRAL] I
[AGENT][NEUTRAL] See, even the physical therapy is in the physical therapy facility. Um, let me see if the
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Let me see if the office.
[CUSTOMER][NEUTRAL] And I don't know if it makes a difference. We do bill as a facility.
[AGENT][NEUTRAL] Like a physical therapy facility?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Well, I mean we do more than just physical therapy, so.
[CUSTOMER][NEUTRAL] I didn't know if they made a difference like when we bill, um, or when we, you know, to make claims, um, we bill as a facility rather than like a professional.
[AGENT][NEUTRAL] It does.
[AGENT][NEUTRAL] So like
[AGENT][NEUTRAL] So when you
[AGENT][NEUTRAL] So when you say in the facility, um rather than professional, so it's, it wouldn't be considered in office, right? The reason I'm asking is because they have an office treatment rider which does cover treatment, but that's in the office setting.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] No.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, you know, so just basically the patients that can, uh, well this insurance will only cover like you said, hospital visits or like actual in facility visits like Smiths and stuff.
[AGENT][NEUTRAL] Because
[AGENT][NEUTRAL] Right, emergency room, urgent care, um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Those types of uh places of service.
[AGENT][NEUTRAL] Now they're primary may though.
[CUSTOMER][NEUTRAL] Oh yeah, the, the patient is just wanting us to also use the secondary side. That's why I'm just calling to verify, yeah.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, well then that's actually all I needed to know then. Um, I don't have any other questions, but can I just use the call reference number just saying I did call to verify eligibility.
[AGENT][NEUTRAL] Of course. So there's no call reference number, but you can use my name in today's date. So again, that's [PII], first initial to my last name is [PII].
[CUSTOMER][POSITIVE] OK, well, thank you, Miss [PII], for your time and help. I really appreciate it.
[AGENT][POSITIVE] You're welcome, [PII]. Well, thanks for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Got it.