AccountId: 011433970860
ContactId: 1ea2a099-bdfd-427e-9b27-187177ca376a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 300000 ms
Total Talk Time (AGENT): 110076 ms
Total Talk Time (CUSTOMER): 131740 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/1ea2a099-bdfd-427e-9b27-187177ca376a_20250409T16:13_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], how are you doing?
[AGENT][POSITIVE] I'm great, how are you?
[CUSTOMER][NEUTRAL] I'm good thanks um I'm calling because my son is has been getting some PT and the people are saying that you guys have not paid anything towards it and that he cannot continue to get his sessions um until the $600 is cleared. Uh, I work for THR and we, uh, you know, we have our own internal benefits department and I reached out to our benefits department and they told me that they don't see the the.
[CUSTOMER][NEUTRAL] That the APL has been used for any physical therapy and that we haven't used the Max for the year so I'm sure I have encountered myself sometimes in the past but sometimes these locations don't know how to file with you um but but confirm for me, you know, yes you guys are gonna pay it or or have have they even submitted anything to you?
[AGENT][NEUTRAL] May I have your policy number and I'll pull up your file.
[CUSTOMER][NEUTRAL] Uh, is the policy number the group number or the payer ID?
[AGENT][NEUTRAL] No, it should say inpatient or outpatient cert number.
[CUSTOMER][NEUTRAL] Oh, OK, uh, so I guess you need the outpatient one?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So it's physical therapy? OK, it's 02.
[CUSTOMER][NEUTRAL] 33
[CUSTOMER][NEUTRAL] 2588 [PII].
[CUSTOMER][NEUTRAL] And the number 8.
[AGENT][POSITIVE] Thank you. May I have your name and a good callback number?
[CUSTOMER][NEUTRAL] Sure, it's [PII]. I'm the policy holder and my number is 954.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. Can you verify your date of birth, your mailing address, and your email, please?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um, what else do you need? Mailing address? [PII].
[AGENT][NEUTRAL] Your mailing address and your
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And what else?
[AGENT][NEUTRAL] And your email address.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for verifying that information. Please be advised that verification of coverage does not guarantee the payment of a claim, and for which dependent are we looking for the physical therapy?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] And it looks like we have claims for 227, 225. It looks like the Be max is met.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Looks like
[AGENT][NEUTRAL] Broward Health submitted a claim in which we processed and maxed out the benefit for 2025.
[CUSTOMER][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Yeah, so it looks like on this claim.
[AGENT][NEUTRAL] On this policy, the calendar year allows $2000 and it looks like once Broward Health submitted that claim, it maxed out the benefits for 2025.
[CUSTOMER][NEUTRAL] I thought this
[CUSTOMER][NEUTRAL] Wow, did our benefit department not increase it? I, I thought that our, our.
[CUSTOMER][NEUTRAL] Our benefit amount was 4000, wasn't it at some point?
[AGENT][NEUTRAL] 4000, 4000 is for inpatient.
[AGENT][NEUTRAL] Outpatient is 2000.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yes ma'am, let me see if you have any other policies, and maybe they changed.
[AGENT][NEUTRAL] No, I'm not seeing any other policies. Sometimes they do change benefits according to policies, but this is the only plan. So you do have inpatient at 4 and outpatient is at 2.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And when does this policy renew?
[AGENT][NEUTRAL] It's year to year, calendar year.
[CUSTOMER][NEUTRAL] Oh, it's calendar year.
[AGENT][NEUTRAL] [PII] to December.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, because our medical just renewed [PII] and I thought this ran with it.
[AGENT][NEUTRAL] Yes, it's a calendar year. Yes, not a planned year, it's a calendar year.
[CUSTOMER][NEUTRAL] I was not aware of that.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, thank you so much I appreciate it.
[AGENT][POSITIVE] [PII], you're so welcome. And thank you for calling American Public Life. Have a great day. Bye-bye.
[CUSTOMER][NEUTRAL] You too bye bye.