AccountId: 011433970860
ContactId: 10b39ccc-2543-4d43-91e8-9352f79554f6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 251300 ms
Total Talk Time (AGENT): 103293 ms
Total Talk Time (CUSTOMER): 85171 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/10b39ccc-2543-4d43-91e8-9352f79554f6_20250122T15:43_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL.
[AGENT][NEUTRAL] This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I work at Southeast Iowa Regional Medical Center, and we have a patient that is, uh, uh, prescribed physical therapy, and, um, APL is his secondary so I was checking to see, I see by the card that there's no pre-certification, um, required, but I didn't know what the benefits were for physical therapy is.
[AGENT][NEUTRAL] Hi, can you hear me?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Um, they're allowed so many visits per calendar year or um anything like that.
[AGENT][NEUTRAL] Sure.
[AGENT][POSITIVE] Oh yeah, I can get that policy pulled up and we will look at that physical therapy benefit. um firstly and if you don't mind, can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Alright thank you and then do you have the policy number?
[CUSTOMER][NEUTRAL] Uh, yes, it is um 01848864.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Excuse me, um, [PII] and his date of birth is [PII].
[AGENT][NEUTRAL] OK, perfect, thank you for verifying that [PII]. Uh, so this policy is active effective date was [PII] and so as this is a secondary medical policy, it is designed to help with co-pay, deductible and co-insurance only after major medical pays. If you'll bear with me one moment, let me get that policy pulled up and we will take a look at the physical therapy benefits.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Of course I will let you know verification of coverage is not a guarantee of payment for claims, so it is covered under their outpatient benefit, uh, physical therapy in a physical therapy facility.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] I don't see any limitations as to how many the visits or anything like that so it would just go out of there.
[AGENT][NEUTRAL] Outpatient benefit let me get that for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alrighty, so their outpatient benefit is $2000 max per calendar year. I know the year just started, but I will go ahead and check to see if any of that has been used.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so none of that has been used so far this year.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] did you have any other questions for me?
[CUSTOMER][NEUTRAL] Uh, no, that was just it. Um, I was just making sure, so, so no pay required, um, there's not a visit limit, but, uh, the max of payout is $2000.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, alright, no, that's all I needed thank you very much, um, unless you do you call reference numbers or?
[AGENT][POSITIVE] Alright, yeah, thanks for calling APL.
[AGENT][NEUTRAL] Um, reference number would just be my first name, last initial, and today's date, uh, so my name.
[AGENT][NEUTRAL] It's spelled [PII] Last initial [PII]
[CUSTOMER][POSITIVE] OK, great. Alright, well thank you very much. I appreciate your help.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Alright, yeah, thanks for calling AP [PII]. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] Uh huh bye bye.