AccountId: 011433970860
ContactId: 0f53c410-677f-4e46-b595-c8e8745d18f0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 306839 ms
Total Talk Time (AGENT): 147996 ms
Total Talk Time (CUSTOMER): 226507 ms
Interruptions: 18
Overall Sentiment: AGENT=1.3, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/0f53c410-677f-4e46-b595-c8e8745d18f0_20250225T19:39_UTC.wav
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[AGENT][POSITIVE] Good afternoon thank you for calling APL.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Can we help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. My name is [PII]. I'm calling from Shan's Teaching Hospital, and I need to get benefits for physical therapy, please, for this patient.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] It would be my pleasure to help you with those benefits, [PII], what is the callback number, please?
[CUSTOMER][POSITIVE] It would be my pleasure to help you. It is [PII].
[AGENT][NEUTRAL] Thank you, [PII], and what is the policy number for the patient?
[CUSTOMER][NEUTRAL] It is 02145412 M as in Mike, L as in Lima, 8.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please, ma'am?
[CUSTOMER][POSITIVE] Thank you [PII].
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Thank you. Good job on that name.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] I was like, it sounded good to me.
[CUSTOMER][NEUTRAL] I was like, I would try my best.
[AGENT][NEUTRAL] I'm, I'm glad it was you trying, not me.
[CUSTOMER][NEUTRAL] What
[AGENT][NEGATIVE] I would have butchered it.
[CUSTOMER][NEUTRAL] No.
[AGENT][POSITIVE] OK, and I can help you with those physical therapy benefits. Let's see, I'm getting those benefits pulled up and I am showing [PII]'s policy is active.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hey this messages pulled up and I am showing [PII]'s policy is active. OK.
[AGENT][NEUTRAL] The effective date is [PII].
[CUSTOMER][NEUTRAL] The effective date is [PII]. OK.
[AGENT][NEUTRAL] This is a secondary policy to the policyholder's major medical insurance.
[CUSTOMER][NEUTRAL] This is a secondary policy to the policy.
[CUSTOMER][NEUTRAL] OK, that's, I kind of figured that I wasn't sure, OK.
[AGENT][NEUTRAL] Mhm. And verifying that physical therapy facility benefit.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Therapy facility. OK.
[AGENT][NEUTRAL] She does have physical therapy facility benefit under her outpatient coverage. That benefit amount is $8000 per calendar year.
[CUSTOMER][NEUTRAL] She does have physical therapy facility benefit under her outpatient coverage amount is $8000 per calendar year. That is the verification coverage and not a guarantee of payment. OK.
[AGENT][NEUTRAL] And that is a verification of coverage and not a guarantee of payment.
[CUSTOMER][NEUTRAL] Now is that like an out of pocket or what is that exactly?
[AGENT][NEUTRAL] So that
[AGENT][NEUTRAL] Sure, that is what we can pay toward her deductible, co-pay or co-insurance of her major medical. So after they process the claim after primary processes, then you would send the claim with the primary EOB to us for processing.
[CUSTOMER][NEUTRAL] That is what we can pay towards her deductible co-pay or co-insurance of her.
[CUSTOMER][NEUTRAL] So after they process the claim if the primary processes, then you would send the claim with the primary EOB to us for processing.
[CUSTOMER][NEUTRAL] OK, so that is the max that you will pay, correct?
[AGENT][NEUTRAL] For calendar year. Mhm.
[CUSTOMER][NEUTRAL] Per calendar year, OK, now is there a co-pay or a deductible or how does that work?
[AGENT][NEGATIVE] Not on this plan.
[CUSTOMER][NEUTRAL] OK, so what, OK, OK, no copay.
[AGENT][POSITIVE] This helps covers her covers her deductible or copay of her primary insurance.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And again, that is a verification of coverage, not a guaranteed payment, sorry.
[CUSTOMER][NEUTRAL] And we'll like.
[CUSTOMER][NEUTRAL] OK, do they need uh prior authorization?
[AGENT][NEUTRAL] With APL prior authorization is not required if we do follow the guidelines for the major medical.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] required and are there any limitations?
[AGENT][NEUTRAL] No ma'am, not on this plan.
[CUSTOMER][NEUTRAL] OK, alright.
[CUSTOMER][POSITIVE] Awesome.
[CUSTOMER][NEUTRAL] All right, and then if I could just get your name I didn't, I didn't hear it at the beginning.
[AGENT][NEUTRAL] Not a problem. My name is [PII]
[CUSTOMER][NEUTRAL] Not a problem. My name is [PII]
[AGENT][NEUTRAL] First initial last name [PII].
[CUSTOMER][NEUTRAL] First initial last name [PII].
[CUSTOMER][NEUTRAL] OK, and then if I can just get a, yes, go ahead.
[AGENT][NEUTRAL] And the reference?
[AGENT][NEUTRAL] Number is what is my name in today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] And it's funny because that's exactly how I spell my first name, but I pronounce it in Spanish. Mhm that's [PII], yes.
[AGENT][NEUTRAL] Is it?
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] That's
[CUSTOMER][NEUTRAL] That's uh that's why I don't use it a lot because they, they usually call me [PII]. I said no, it's [PII]. I said, so I go by my middle name, [PII].
[AGENT][NEUTRAL] There you go.
[CUSTOMER][NEUTRAL] Yes, so [PII].
[AGENT][NEUTRAL] Well, I, they, you know, they call me everything from [PII] to [PII] to [PII], [PII]. I'm just like, OK. Yup, that's my name.
[CUSTOMER][NEUTRAL] Uh yeah, that's me.
[AGENT][POSITIVE] Let's go with it.
[CUSTOMER][POSITIVE] All right, Ms. [PII]. Well, I appreciate your help and I hope you enjoy the rest of your day.
[AGENT][POSITIVE] [PII], it's been such a pleasure to assist you and I hope you enjoy your day as well. Or [PII], [PII].
[CUSTOMER][NEUTRAL] Sisters
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] [PII], there you go. Thank you so much.
[AGENT][POSITIVE] I got you. You have a wonderful day as well, and thank you for calling APL. Take care.
[CUSTOMER][POSITIVE] Have a good one.
[CUSTOMER][POSITIVE] Yes ma'am, yes ma'am bye bye.
[AGENT][NEUTRAL] Bye-bye.