AccountId: 011433970860
ContactId: 0cd5d377-3f7d-46fb-abc4-496a4491d28f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 290829 ms
Total Talk Time (AGENT): 140215 ms
Total Talk Time (CUSTOMER): 110686 ms
Interruptions: 4
Overall Sentiment: AGENT=1.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/0cd5d377-3f7d-46fb-abc4-496a4491d28f_20250107T21:48_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, I'd like to verify um outpatient hospital based physical therapy benefits, please. Our patient said he has APL as a secondary.
[AGENT][POSITIVE] Got you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, yeah, I can check to see if uh physical therapy would be covered under that policy. Um, what was your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. Do you have the policy number?
[CUSTOMER][NEUTRAL] I do.
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] 01907491
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] And what is your name?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][POSITIVE] Thanks care.
[AGENT][NEUTRAL] Of course, uh, what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, well, I might have, uh, misheard that policy number because I got somebody else. I'm so sorry. Uh, could you repeat the policy number to me?
[CUSTOMER][NEUTRAL] 01907491
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, yeah, that's what I got and that's um somebody else entirely um.
[AGENT][NEUTRAL] OK, let's, uh, yes, let's see, um, do you maybe, oh sorry, go ahead.
[CUSTOMER][NEUTRAL] Really?
[CUSTOMER][NEUTRAL] OK, well, let me, you know what, let me check here. I'm gonna check in his uh.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Check because that is what the doctor's office had on their slip. Let me look and see what.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, yeah, this is different policy 01907891.
[AGENT][NEUTRAL] Ah, OK.
[AGENT][NEUTRAL] Let's say.
[CUSTOMER][NEUTRAL] Oh, they have 074 07891.
[AGENT][NEUTRAL] Yeah, OK.
[AGENT][NEUTRAL] There we are alright and I'm sorry, what was [PII]'s uh date of birth please?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Perfect. OK, thank you for verifying all of that.
[AGENT][NEUTRAL] Alrighty, so yes, this policy is active, uh, effective date was [PII]. Give me one moment, I will get the policy pulled up here.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I'm sorry, could you repeat that?
[AGENT][NEUTRAL] Oh sure, um, effective date was [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and bear with me just a moment. I'm getting the policy pulled up and I will see if uh.
[AGENT][NEUTRAL] Physical therapy is covered.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] And while I'm getting this up, um, if you're unaware, uh, this policy as it is secondary is very dependent on major medical, so if their primary does not pay, this policy can't. If they do, then this policy can help.
[CUSTOMER][NEUTRAL] Yeah I don't
[CUSTOMER][NEGATIVE] No, I know I was afraid of that because he's like I don't know what to do with them.
[CUSTOMER][POSITIVE] I had a feeling we were gonna end up with them regardless.
[CUSTOMER][NEUTRAL] OK, yeah, the po the the first policy is United Healthcare and I verified with them they're paying.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Got it. OK, so yes.
[AGENT][NEUTRAL] Uh, OK, and of course I will let you know uh verification of coverage is not a guarantee of payment for claims, so that is covered outpatient, uh, physical therapy in a physical therapy facility is covered. And so the their outpatient benefit is on a per calendar day basis.
[AGENT][NEUTRAL] And so that's going to be.
[AGENT][NEUTRAL] Wow, uh, $6800 max per calendar day.
[CUSTOMER][NEUTRAL] They pay that much for physical therapy.
[AGENT][NEUTRAL] That's just the total outpatient benefit for us.
[AGENT][NEUTRAL] I know that's gotta be the heftiest one I've seen, yeah, the, well, per calendar day that's up to the amount that we would pay the benefit amount we would pay.
[CUSTOMER][NEUTRAL] Oh, the total outpatient.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK then um do you have a reference number for the call?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] That would just be my first name, last initial, and today's date.
[AGENT][NEUTRAL] And so my last initial is [PII]
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And was there anything else I could help you with [PII]?
[CUSTOMER][NEUTRAL] No, [PII] A and then 1725.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] That's it, yes ma'am.
[CUSTOMER][POSITIVE] Thank you I appreciate you.
[AGENT][POSITIVE] Of course, yeah, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] Right
[AGENT][POSITIVE] Thank you.