AccountId: 011433970860
ContactId: 142050f1-605a-43f4-9d42-a57187f0edb5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 251089 ms
Total Talk Time (AGENT): 124589 ms
Total Talk Time (CUSTOMER): 73322 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/12/142050f1-605a-43f4-9d42-a57187f0edb5_20250612T15:16_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good morning. This is [PII] calling from AT Physical Therapy provider's office to check patient eligibility and benefits.
[AGENT][NEUTRAL] OK, I can check eligibility and benefits for you. I'm sorry, you said your name was [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, uh, can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] it's a direct line.
[AGENT][NEUTRAL] OK, thank you and then do you have that policy number?
[CUSTOMER][NEUTRAL] Yes, one moment.
[CUSTOMER][NEUTRAL] The ID number is
[CUSTOMER][NEUTRAL] 1451702 ML 8.
[AGENT][NEUTRAL] OK and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] First name is [PII], last name is [PII], and her date of birth is [PII].
[AGENT][POSITIVE] Perfect, thank you for verifying that. So this policy is active. Effective date was [PII].
[AGENT][NEUTRAL] And this is a secondary medical policy, so it is designed to help with co-pay, deductible and co-insurance after major medical pays. And we we needing to look at inpatient or outpatient benefits for this number?
[CUSTOMER][NEUTRAL] Outpatient?
[AGENT][NEUTRAL] OK, and of course I will let you know verification of coverage is not a guarantee of payment for claims. The outpatient benefit is $6000 per calendar year and if you'll give me one moment, I will see if any of that has been used.
[CUSTOMER][NEUTRAL] OK. And this is out of pocket or deductible?
[AGENT][NEUTRAL] Uh, no, no, no, neither, um, that's the total benefit amount, the payable benefit amount that we would pay.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and none has been used so far this year, so she does have that full benefit amount uh this policy does not have any out of pocket or deductibles.
[CUSTOMER][NEUTRAL] OK, and Copay coinsurance?
[AGENT][NEUTRAL] So this follows major medical, uh, there is no co-pay. It is designed to help with co-pay, deductible and co-insurance up to that $6000 benefit amount per calendar year.
[CUSTOMER][POSITIVE] Mm, OK, benefits. Thank you so much. And can you please confirm the policy type and the insurance name?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It's secondary medical. The name is [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] One moment.
[CUSTOMER][POSITIVE] Thank you so much. Can you please spell your name?
[AGENT][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] Oh, is there anything else I could help you with?
[CUSTOMER][NEUTRAL] Can you please confirm the claim mailing address?
[AGENT][NEUTRAL] Of course I've also got a fax number and a payer ID if you'd like that mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that is in [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, thank you so much. One moment. Once again, the [PII]. Is it right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] OK. Thank you so much for information. And I think that's it for today. Thank you. Can I get the call reference number?
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date. uh so my last initial is A.
[CUSTOMER][POSITIVE] OK, uh thank you so much for the information and you have a great day. Thank you bye.
[AGENT][NEUTRAL] Of course.
[AGENT][POSITIVE] Yeah, thanks for calling APL you too bye bye.