AccountId: 011433970860
ContactId: 0bbc8f13-4563-44f5-916c-2bb607fc950a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 200479 ms
Total Talk Time (AGENT): 112870 ms
Total Talk Time (CUSTOMER): 72925 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/0bbc8f13-4563-44f5-916c-2bb607fc950a_20250210T14:19_UTC.wav
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[AGENT][POSITIVE] Good Morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][POSITIVE] Yes ma'am, I'm calling to get benefits on a patient for outpatient physical therapy done in the office.
[AGENT][NEUTRAL] It
[AGENT][POSITIVE] All right. Thank you. And it would be my pleasure to assist you. May I ask your name?
[CUSTOMER][NEUTRAL] [PII], and I'm sorry, what was yours?
[AGENT][POSITIVE] Thank you, [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yes, ma'am. And [PII], it is so Monday, I'm telling you.
[CUSTOMER][NEUTRAL] It's Monday.
[AGENT][NEUTRAL] And all this glory is my, my grandmother used to say, What's that callback number, [PII]?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Exactly.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient?
[CUSTOMER][NEUTRAL] 2180309
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please, ma'am.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] All right, thank you, and it would be my pleasure to help you with the eligibility and outpatient physical therapy benefits for [PII]. I'm showing that her policy is active.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Effective date is for [PII].
[AGENT][NEUTRAL] She does have physical therapy benefits under her outpatient coverage of up to $6000 per calendar year.
[AGENT][NEUTRAL] That is a verification of coverage and not a guarantee of payment.
[AGENT][NEUTRAL] At this time, she has that full benefit remaining for [PII].
[CUSTOMER][NEUTRAL] So is this considered an out of pocket amount or a deductible?
[AGENT][NEUTRAL] This is her secondary policy. We cover the deductible, co-pay or co-insurance of the primary medical um insurance.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] So there's no deductible or co-pay on this policy.
[CUSTOMER][NEUTRAL] You'll just pay out $6000.
[AGENT][NEUTRAL] Right, toward her deductible, co-pay or co-insurance of the major medical. So when they process the claim, whatever they apply to the deductible or co-pay or co-insurance.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Y'all will cover it.
[AGENT][POSITIVE] Up to that maximum benefit. You got it.
[CUSTOMER][NEUTRAL] Up to $6000.
[CUSTOMER][NEUTRAL] Got it, and that applies to surgeries as well, correct? So like if she had a surgery and then therapy and stuff like that after.
[AGENT][NEUTRAL] It does.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] And you said 0 has been paid out?
[AGENT][NEUTRAL] As of right now.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Alright, that's all I needed, and I'm assuming a pre-au is not required if.
[AGENT][NEUTRAL] Well, they said
[AGENT][NEUTRAL] Follows the guidelines of the major medical, so it's not required. Yeah.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Not required, all right, thank you very much you have a reference number?
[AGENT][NEUTRAL] It would be my name in today's date and I spell my name, [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And we, it was a pleasure to help you with those benefits. Anything else I can help you with today?
[CUSTOMER][POSITIVE] Thank you you too.
[CUSTOMER][POSITIVE] No, that's it I hope you have a good one.
[AGENT][POSITIVE] I hope you do too, [PII]. Thank you for calling APL. Take care.
[CUSTOMER][NEUTRAL] They
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye-bye.