AccountId: 011433970860
ContactId: 28206be4-c7e3-4689-a574-f0c4bece7272
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 643770 ms
Total Talk Time (AGENT): 158925 ms
Total Talk Time (CUSTOMER): 151800 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/28206be4-c7e3-4689-a574-f0c4bece7272_20250416T19:35_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Uh, hi, [PII]. And my name is [PII]. I'm calling from the provider's office and before going further, I would like to mention this call is being recorded for quality and training purposes. So will that be OK?
[AGENT][NEUTRAL] Yes. And how do you spell your name?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And do you have a phone number I can get in case we get disconnected, I can call you back?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] Yes. So the policy number is 02595525.
[AGENT][NEUTRAL] And what's the patient's name?
[CUSTOMER][NEUTRAL] Name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you, [PII], and you are needing claim status?
[CUSTOMER][NEUTRAL] Sorry, uh the address, it's [PII].
[AGENT][NEUTRAL] OK, were you needing claim status or benefits?
[CUSTOMER][NEUTRAL] Oh, I need eligibility and benefits for physical and occupational therapy done in office by a specialist.
[AGENT][NEUTRAL] OK, the effective date is [PII]. Any benefits given over the phones, not a guarantee of payment.
[AGENT][NEUTRAL] Hold on just a moment.
[AGENT][NEUTRAL] And you said this was for uh physical therapy and occupational therapy?
[CUSTOMER][POSITIVE] That is right.
[AGENT][NEUTRAL] OK, hold on one moment. It's gonna take me just a few minutes.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, for physical and occupational therapy, $30 per day with a maximum of 4 days per calendar year.
[CUSTOMER][NEUTRAL] A maximum of 4 days only for per calendar year.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And no additional visit will be granted.
[AGENT][NEGATIVE] No, it says only 4 days per calendar year per covered person, $30 per day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is it, the visits are combined between PT and OT?
[AGENT][NEUTRAL] Do what now?
[CUSTOMER][NEUTRAL] Uh, the visits, the 4 visits, is it combined?
[AGENT][NEUTRAL] Combined, yes.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] And have they used any of those visits?
[AGENT][NEUTRAL] Hold on and I'll check.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEGATIVE] No, they have not used anything.
[CUSTOMER][NEUTRAL] Got it. What about the out of pocket?
[AGENT][NEUTRAL] Whatever is left over would be their responsibility. That's all we're going to pay is the $30 per day.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Can you also give me the out of network benefits? These are the network benefits, right?
[AGENT][NEUTRAL] These are out or this is what we paid regardless.
[CUSTOMER][NEUTRAL] Oh, OK, got it. Thank you. And can you check if prior authorization is required for those two services?
[AGENT][NEUTRAL] We do not require pre-authorization.
[CUSTOMER][NEUTRAL] All right, got it.
[CUSTOMER][NEUTRAL] And what is the payer ID and claims mailing address?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Let's see, the payer ID for this policy is 64556.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it's PO Box.
[AGENT][NEUTRAL] 248. 0, hold on just a moment. I'm sorry, I gave you the wrong one.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, it's, it'll go to uh [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 551 21.
[AGENT][NEUTRAL] Payer ID is 64556.
[CUSTOMER][POSITIVE] Got it thank you so much.
[CUSTOMER][NEUTRAL] And can you also check for general telehealth benefits?
[AGENT][NEUTRAL] If he what now?
[CUSTOMER][NEUTRAL] A telehealth benefits, are those covered under this plan?
[AGENT][NEGATIVE] I still didn't understand what you said. I couldn't hear you.
[CUSTOMER][NEUTRAL] Uh, at Telehealth, the virtual visit covered on this visit?
[AGENT][NEUTRAL] Is what covered?
[CUSTOMER][NEUTRAL] Telehealth, virtual visits.
[AGENT][NEUTRAL] You said telehealth?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] For office visits or for physical therapy?
[CUSTOMER][NEUTRAL] Office.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it's for an office visit?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] On office visits, we pay $50 per day, a maximum of 4 days per calendar year per covered person.
[CUSTOMER][POSITIVE] Got it. Thank you so much. And what is the plan type?
[AGENT][NEUTRAL] It's just a hospital indemnity policy.
[CUSTOMER][NEUTRAL] Indemnity, got it.
[CUSTOMER][NEUTRAL] And policy runs through a calendar year, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] What is the effective date?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. Got it.
[CUSTOMER][NEUTRAL] And is this a self-funded or fully funded plan?
[AGENT][NEUTRAL] It is through their employer.
[CUSTOMER][NEUTRAL] And uh is it possible for you to check if they have any spending account like HRA or HSC?
[AGENT][NEUTRAL] I wouldn't know that.
[CUSTOMER][NEUTRAL] Oh, got it.
[CUSTOMER][NEUTRAL] And also, can you check if the provider is in network or out of network with the member's plan?
[AGENT][NEUTRAL] Uh, you would have to contact multiplan. Our providers go through multiplan.
[CUSTOMER][POSITIVE] OK, got it. No problem. Thank you so much for your assistance and can you spell me your name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] And the initial and last name?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Can you give me a call reference number?
[AGENT][NEUTRAL] We do not have call reference numbers. You can use my name in today's date.
[CUSTOMER][POSITIVE] Got it. Thank you so much, [PII], for your assistance. Have a great day ahead.
[AGENT][POSITIVE] Thank you for calling APLU as well.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Bye-bye.