AccountId: 011433970860
ContactId: fee38abd-81ab-45de-8843-a49209e28bb3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 261130 ms
Total Talk Time (AGENT): 111884 ms
Total Talk Time (CUSTOMER): 79851 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/25/fee38abd-81ab-45de-8843-a49209e28bb3_20250325T15:19_UTC.wav
--------------------------------------------
[CUSTOMER][NEUTRAL] Um, I
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, um, my name is [PII]. I'm from Atlantic Therapy. I just need some questions answered on some eligibility, um, for a mutual patient.
[AGENT][NEUTRAL] Sure, I can check that eligibility for you. I'm sorry, you said your name was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK and then can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Yes, it's uh 02451593 ML 8.
[AGENT][NEUTRAL] OK. And uh what was the name and date of birth for the patient, please?
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII], it's uh [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that. Uh, so this policy is active. Effective date was [PII], and this is a secondary medical policy, so it is designed to help with co-pay, deductible and co-insurance after major medical pays.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, so these are my questions. Do you pick up the deductible for um that she has with United Healthcare?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes, yeah, that's what this plan is designed to help with, um, so yeah, copay deductible and then co-insurance.
[CUSTOMER][NEUTRAL] So you pick up the coinsurance and the deductible, OK, and what about the copay?
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Yes, it can assist with that as well.
[CUSTOMER][NEUTRAL] And do you have an office limit?
[AGENT][NEUTRAL] Um, let me check to make sure that office visits are covered under this policy. Uh, they are all a bit different. Oh, physical therapy, OK. Let me make sure that is a covered benefit. Bear with me just a moment.
[CUSTOMER][NEUTRAL] Is it
[CUSTOMER][NEUTRAL] This is the physical therapy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, uh huh.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Sorry, it's thinking about it. Bear with me just a moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you so much for your patience. Um, so I of course I will let you know verification of coverage is not a guarantee of payment for claims. Uh, so physical therapy performed in a physical therapy facility is going to be covered under their outpatient benefit. So their outpatient benefit is on a per calendar day basis, so it pays up to $500 per calendar day. And again, that can go towards co-pay, deductible or co-insurance.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] He's up to
[CUSTOMER][NEUTRAL] $500 a day.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] You said right or a day or calendar year.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Per calendar day, um, no, no, no, per calendar day there's no yearly, uh, max, it's just a daily max.
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alrighty and then uh so that's um.
[CUSTOMER][NEUTRAL] Is there a limit in visits?
[AGENT][NEGATIVE] No, not, not for this.
[CUSTOMER][POSITIVE] No limit in this OK.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and what's your name?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][POSITIVE] OK great alrighty thank you so much.
[AGENT][NEUTRAL] Yeah, did you have any other questions for me?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] Alright, well thanks for calling APL Matallina. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you. Bye-bye.