AccountId: 011433970860
ContactId: 178a6230-fdca-4ccf-a882-f94f1e906ee3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 322279 ms
Total Talk Time (AGENT): 143149 ms
Total Talk Time (CUSTOMER): 122280 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/178a6230-fdca-4ccf-a882-f94f1e906ee3_20250106T14:09_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey [PII], my name is [PII] and I need to get benefits on a patient please.
[AGENT][NEUTRAL] I can help you, [PII]. Is this for um office visit service?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] And if I can get the policy number and a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] 02510727 M as in Mary, L as in Larry 8.
[AGENT][POSITIVE] And a good callback number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Thank you for that information, [PII]. What's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, [PII] [PII].
[AGENT][POSITIVE] Thank you for that information.
[AGENT][NEUTRAL] So I show the policy effective date is [PII]. Uh this policy is active at this time and we're checking for office visit benefit, correct?
[CUSTOMER][NEUTRAL] Yes, physical therapy done in the office.
[AGENT][NEUTRAL] OK, so the maximum outpatient benefit is up to $3000.
[AGENT][NEUTRAL] That is per calendar day.
[AGENT][NEUTRAL] And information provided is verification, not a guarantee of payment. And did you have any other questions I can help out with today, [PII]?
[CUSTOMER][NEGATIVE] So there's no, there's no visit limit. she's not responsible for anything, it's just y'all cover up to $3000.
[AGENT][NEUTRAL] No visit limit, it's $1 maximum per calendar day, which is $3000. Uh, this policy is secondary to the primary insurance plan. This policy will reimburse cover charges applied towards the major medical deductible, co-insurance and or co-pay amounts of up to $3000 per calendar day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And that's all services.
[AGENT][NEUTRAL] You said physical therapy, right?
[CUSTOMER][NEUTRAL] Not just, yeah, yeah, so is this just for physical therapy?
[AGENT][NEUTRAL] It's not. It's just the outpatient benefits, so it's not specific to physical therapy.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yeah, that's why I was asking if it was all so if she goes to the doctor today and then she goes to another doctor visits, it's all doctor visits, right?
[AGENT][NEUTRAL] So the uh the physician's visit isn't covered. It's the treatment that's covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, I think that there's some that's why I'm calling back because there's some some differences in the the the wording of how things so that's why I'm asking a lot of questions.
[AGENT][NEUTRAL] Oh, as far as the wording previously provided?
[CUSTOMER][NEUTRAL] Mhm, from previously to mhm yeah.
[AGENT][NEUTRAL] What, OK, what do you have?
[CUSTOMER][NEUTRAL] Um, that there is no patient responsibility at the 24 visits, um, and that's it.
[AGENT][NEUTRAL] That sounds like it could be for the major medical plan.
[CUSTOMER][NEUTRAL] Yeah, so yeah.
[AGENT][NEUTRAL] And not for the secondary, which is who you're speaking with, the secondary payers, American Public Life.
[CUSTOMER][NEUTRAL] Right, right, yeah, so is that.
[AGENT][NEUTRAL] So that could be for the primary.
[CUSTOMER][NEUTRAL] No, that was what was given, um, previously when we called.
[CUSTOMER][NEUTRAL] And got a different rep, not you, so my name is [PII].
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, but
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So that's why I called back to make sure.
[AGENT][NEUTRAL] Let me look
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me one second. Do you know when that call was made?
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Was it back in September? OK, let me see.
[CUSTOMER][NEUTRAL] Um, it's been a couple of months ago, yes, ma'am.
[CUSTOMER][NEUTRAL] That would be great if you can tell me what was said.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, it just says [PII] with provider's office called to see if physical therapy is covered. I told her it is and explained that major medical has to pay first before this policy can.
[AGENT][NEUTRAL] That's what's documented in her notes.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alrighty, so it covers up to 3000 per calendar day.
[CUSTOMER][NEUTRAL] For treatment only, not physician and it's secondary to the other plan that she has.
[AGENT][POSITIVE] Correct. And it'll, yes, it'll cover uh any amounts applied towards the physical therapy treatment, um.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Whether it's applied towards deductible, co-insurance amount, or co-pay amount.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Does that make sense?
[CUSTOMER][NEUTRAL] Alright, is there a call reference? It does. I'm just writing down notes. So is there a call reference number or is it just your name?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, that's fine.
[AGENT][NEUTRAL] Mm yeah, you'll use my name in today's date as your reference and we document each call.
[CUSTOMER][POSITIVE] OK awesome alrighty thank you.
[AGENT][POSITIVE] Oh, you're welcome. Anything else I can help out with today?
[CUSTOMER][NEUTRAL] No ma'am, that'll do it.
[AGENT][POSITIVE] OK, well, thank you for calling APL. Have a good day.
[CUSTOMER][POSITIVE] You too hon, thank you.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.