AccountId: 011433970860
ContactId: 041c3f1e-e45d-494c-ba4a-66ca4855df52
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 257720 ms
Total Talk Time (AGENT): 132140 ms
Total Talk Time (CUSTOMER): 83009 ms
Interruptions: 0
Overall Sentiment: AGENT=2.9, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/041c3f1e-e45d-494c-ba4a-66ca4855df52_20250102T16:43_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Hi, thanks for calling ATL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi [PII], good good morning. My name is [PII]. I'm calling to see if this APO policy is covering physical therapy for this patient, please.
[AGENT][POSITIVE] Yeah, I'd love to take a look at that coverage for you, my friend. Um, and may I have the policy number we want to look at?
[CUSTOMER][NEUTRAL] Yes, 02419330.
[AGENT][POSITIVE] Wonderful, and I'm so sorry I didn't quite catch your name. Can I get that again?
[CUSTOMER][NEUTRAL] Yes, [PII]
[AGENT][POSITIVE] Wonderful and [PII], do you mind if I also get a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, absolutely, it's [PII].
[AGENT][POSITIVE] Thank you. I appreciate that. And your patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] The patient's name is [PII] and it's [PII].
[AGENT][POSITIVE] Perfect, I really appreciate that and give me one second to look into this patient for you.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] All right. Your patient is current and active with an effective date of [PII]. And you said we're looking at physical therapy benefits, is that correct?
[CUSTOMER][POSITIVE] That is correct.
[AGENT][NEUTRAL] All right. Um,
[AGENT][NEUTRAL] And I'm just waiting for that benefit screen to load for me. Give me one moment or two.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] Um, while I'm waiting for that to load, I do want to let you know that your patient does have an updated policy number. Um, can I get that policy number to you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so the updated policy number is?
[AGENT][NEUTRAL] It is 02556434.
[CUSTOMER][NEUTRAL] 34 OK.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] I'm just scrolling
[CUSTOMER][NEUTRAL] And the group number will be the same or no?
[AGENT][NEUTRAL] Oh yes, that will be the same.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. It looks like they do have physical therapy coverage in a physical therapy facility under their outpatient benefits. It looks like for outpatient benefits, we have a maximum of
[AGENT][NEUTRAL] $8700 per person per calendar year with no deductible, uh, granted that is just a verification of coverage and not a guarantee of payment.
[CUSTOMER][NEUTRAL] You said this is um this is per patient per day.
[AGENT][NEUTRAL] Uh, per patient per year, $8700.
[CUSTOMER][POSITIVE] Patient per year OK per year perfect.
[CUSTOMER][NEUTRAL] OK this is for outpatient you said.
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] OK, OK, and nothing has been used I'm assuming.
[AGENT][NEGATIVE] Not for this calendar year.
[CUSTOMER][POSITIVE] [PII] used OK.
[CUSTOMER][POSITIVE] Perfect, thank you very much for that update and um can I have a reference number for this call if possible?
[AGENT][NEUTRAL] Oh yeah, it's gonna be my name, [PII], first initial last name, [PII], and today's date.
[CUSTOMER][NEUTRAL] OK, and then I also have another question that I wanna ask you. um, you said that this does this covers physical therapy though PT is covered under this.
[AGENT][NEUTRAL] It looks like their benefits, um, it states in a physical therapy facility, so I'm assuming it would cover the treatment done in that facility.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, but it's gonna be depending on how their major medical pays. So we base it off of what they're, cause we're like a gap insurance so we base it off their major medical.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect thank you so much for that information, OK?
[AGENT][POSITIVE] Yeah my pleasure. Is there anything else I can do for you?
[CUSTOMER][POSITIVE] No, that'll be all thank you very much.
[AGENT][POSITIVE] Hey my pleasure, thank you.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye bye.