AccountId: 011433970860
ContactId: fdd59fc7-4a14-4ef0-9efe-6a2ee8e1e96b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 592219 ms
Total Talk Time (AGENT): 215063 ms
Total Talk Time (CUSTOMER): 288560 ms
Interruptions: 3
Overall Sentiment: AGENT=1.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/fdd59fc7-4a14-4ef0-9efe-6a2ee8e1e96b_20250220T19:40_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[AGENT][POSITIVE] Good afternoon. Thank you.
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello, this is [PII] spelled [PII] And I'm calling you from the facility and I'm here to get the benefits for the member. Is this provider line?
[AGENT][POSITIVE] Yes, I'll be more than happy to help you with the benefits. And may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Sure, it's like [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] I'm I'm.
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Sure, I'm looking into that. And the member's ID number would be like 016602.
[CUSTOMER][NEUTRAL] 59 M as in Mike. L as in Lima, number 8.
[AGENT][NEUTRAL] Thank you for that. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] My first name would be like [PII] and the last name would be like uh [PII]
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And the date of birth?
[CUSTOMER][NEUTRAL] [PII]. Sure. And the date of birth would be like?
[CUSTOMER][NEUTRAL] Um [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And I am showing the policy is active, it's been effective since [PII]. And what type of benefits did you want to go over today?
[CUSTOMER][NEUTRAL] 97
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 712
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm looking for physical therapy benefits.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] What what is?
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Yeah, please check a CPA bag.
[AGENT][NEUTRAL] Uh hold on one moment.
[AGENT][NEUTRAL] So I'm showing for physical therapy, um, that's under outpatient, it will pay up to $5000 per calendar year for outpatient services. This does include physical.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK. Uh,
[CUSTOMER][NEUTRAL] One moment. Uh, it's, it is an office visit and uh it
[CUSTOMER][NEUTRAL] It will be billed for professional. I need professional charges.
[AGENT][NEUTRAL] OK, so as I was stating, it is um for physical therapy and a physical therapy facility. It also covers the office treatment rider, which any treatment that's done in the office could be covered up to that 5000 per calendar year, as long as it's not cosmetic.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Is there any copay?
[AGENT][NEUTRAL] Um, no, this is the secondary insurance. We help pay towards the copay, deductible and co-insurance after primary.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Um, sorry, could you confirm me once again as you are secondary insurance?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] There is no co-pay, right?
[AGENT][POSITIVE] Correct, we help pay the copay that primary.
[AGENT][NEUTRAL] Bills
[CUSTOMER][NEUTRAL] Is there any coincidence?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Again, we pay towards the co-pay, the deductible and co-insurance of coverage charges after primary. So we don't, we don't apply it, we help pay it.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK, uh, you don't have any applicable, uh, like that means there is no co-pay, no coinsurance, and when it comes to deductibles, no deductibles and no, no details, right?
[AGENT][NEUTRAL] Right, the secondary policy helps pay those charges.
[CUSTOMER][NEUTRAL] OK, one moment. I would like to document, uh, all these things. And uh is there any visit limits from your end for the physical therapy services?
[AGENT][NEUTRAL] No, no, there's no number visit limit.
[CUSTOMER][NEUTRAL] Uh, that means it's based on medical necessity, right?
[AGENT][NEUTRAL] The benefit is up to $5000 per calendar year.
[AGENT][NEUTRAL] That can be used at um for office treatment or facility or physical therapy at a facility.
[CUSTOMER][NEUTRAL] I do.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] The benefits are like $5000 per calendar year, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] 5
[CUSTOMER][NEUTRAL] The member can use $5000 at any point of time.
[AGENT][NEUTRAL] For the entire calendar year, any not just physical therapy, all claims that are processed, they have up to $5000. So if other claims come in.
[CUSTOMER][NEUTRAL] Right?
[CUSTOMER][NEUTRAL] Are they in there?
[CUSTOMER][NEUTRAL] OK. Uh,
[CUSTOMER][NEUTRAL] OK, no problem. Uh, how many?
[CUSTOMER][NEUTRAL] Uh, like, out of those $5000 how many dollars is the remaining? Does, does the patient have using any of the limit?
[AGENT][NEUTRAL] Let me see, hold on one moment.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Um, so far they have not used any of the benefits for 2025.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] And remaining would be like 5000, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah,
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And the remaining is also like 5000. There is no visit limit, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And I just.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Can I consider it's based on medical necessity?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, can I consider the visit limits? Uh, it's based on medical necessity?
[AGENT][NEUTRAL] Visit you said can you, can the visit limits be based on medical necessity?
[CUSTOMER][NEUTRAL] Yeah. Can I use that term?
[CUSTOMER][NEUTRAL] I
[AGENT][NEGATIVE] I don't understand what you're asking.
[CUSTOMER][NEUTRAL] OK. Um, also help me with the eligibility details.
[AGENT][NEUTRAL] Help you, can you slow down, please help you with what?
[CUSTOMER][NEUTRAL] Eligibility details of the member.
[CUSTOMER][POSITIVE] Thank you so much for your valuable information and your time, [PII].
[AGENT][NEUTRAL] The policy is active and has, well, actually, hold on one second.
[CUSTOMER][POSITIVE] Oh, good.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, so the policy is active, it's been effective since [PII]?
[CUSTOMER][NEUTRAL] OK. Trans on a calendar plan, right?
[AGENT][POSITIVE] Calendar year, yes, that's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, may I know the plan type as well?
[AGENT][NEUTRAL] This is their Medlink supplemental policy?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Like plan type, not the plan name.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Are you asking me for, what do you mean plan type? The plan are you asking me this, if it's like an individual or family?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] No, uh, the plan I would be like generally PPO, POS and HMO plans.
[AGENT][NEUTRAL] Right, this is a secondary policy. So the plan type is a Medlink policy. There's no PPO or HMO that's for primary or major insurance.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] meddling policy, right?
[AGENT][NEUTRAL] The Medin supplemental insurance policy?
[CUSTOMER][NEUTRAL] OK. Just to confirm that the plan I would be like meddling supplementary policy, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh-huh. And uh there is no refund required, right?
[AGENT][NEUTRAL] Correct, no no um referrals are required for our policies.
[CUSTOMER][NEUTRAL] And no authorization is also required.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] My
[CUSTOMER][NEUTRAL] OK. Uh, I do have some set of CPT codes with me. I would like to verify whether they are covered under the member's plan or not.
[AGENT][NEUTRAL] Our policies don't go by um procedure codes. It goes by place of service as an inpatient or outpatient.
[AGENT][NEUTRAL] So the physical therapy facility is under outpatient, which is the benefits I've quoted.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, you can't able to provide whether they are, they are valid and available or covered, right?
[AGENT][NEUTRAL] Right, there's no our policies don't go by CPT codes. There's no, there's nothing for me to reference with the codes.
[AGENT][NEUTRAL] It's based on the place.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] It's based on the place. OK, thank you. Help me with the card reference. Uh, just before that, could you, could you help me with the, uh, with your name?
[AGENT][NEUTRAL] There's
[AGENT][NEUTRAL] Yes, my name is [PII], and there's no um call reference number, but you can use my name and today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, your name and today's date.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] OK. Thank you very much. Thanks for the information. Have a great day. Bye-bye.
[AGENT][POSITIVE] You're very welcome. Thanks for calling APL. Was there anything else I can assist you with?
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] All right, thanks for calling APL. Have a good day. Bye-bye.
[CUSTOMER][NEUTRAL] Yeah