AccountId: 011433970860
ContactId: 29df5ca7-21df-4a32-bede-8792c476e529
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 244119 ms
Total Talk Time (AGENT): 93227 ms
Total Talk Time (CUSTOMER): 108538 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/26/29df5ca7-21df-4a32-bede-8792c476e529_20250626T14:06_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, ma'am. This is [PII] calling from provider's office to check on the benefits for a patient.
[AGENT][POSITIVE] Sure, [PII], I can assist you with that.
[AGENT][NEUTRAL] I have a callback number for you.
[CUSTOMER][NEUTRAL] Oh yes, it's gonna be [PII] direct line.
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] Uh-huh. [PII].
[AGENT][NEUTRAL] [PII], what is the policy number of the member that you're calling to verify eligibility for today?
[CUSTOMER][NEUTRAL] Oh yes, I, my mom.
[CUSTOMER][NEUTRAL] Just a second, ma'am. Just a second, please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you for your patience and the member ID is gonna be um 018.
[CUSTOMER][NEUTRAL] 29134 M as in Mary, L as in Lima, number 7.
[AGENT][NEUTRAL] Thank you, [PII]. Could you verify the patient's name and date of birth and I'll be able to assist you.
[CUSTOMER][NEUTRAL] Oh yes, it's [PII] of [PII].
[AGENT][NEUTRAL] Calling to verify benefits eligibility. This member's policy has been active since [PII] and it's currently active.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Thank you. Um, I need some specific benefits, by the way, for the CPT code and then I will provide the CPT code and the uh DX code.
[AGENT][NEUTRAL] What is the place of service?
[CUSTOMER][NEUTRAL] It's gonna be the outpatient hospital facility settings.
[AGENT][NEUTRAL] So the member's policy has outpatient benefits of $500 per calendar day and this is not a guaranteed benefits just a disclaimer of the policy's coverage and this is a gap insurance on a primary, so no pre-authorization is required.
[CUSTOMER][NEUTRAL] Thank you, ma'am. Actually, uh, the, the patient has a primary insurance of Cigna. Um, the patient have, uh, as a treatment of physical therapy, uh, is going to have a physical therapy. Is the physical therapy treatment is covered by the American public life?
[AGENT][POSITIVE] Yes, that is correct. It falls on the outpatient benefits.
[CUSTOMER][NEUTRAL] Total, how much, how much of $500 right?
[AGENT][NEGATIVE] $500 per calendar day for outpatient services and this is not a guaranteed benefits just a disclaimer of the policy's coverage.
[CUSTOMER][NEUTRAL] May I know how much was made uh made for for uh for this $500?
[AGENT][NEUTRAL] $500 per calendar day per day.
[AGENT][NEUTRAL] Like today is Thursday, he has $500 for.
[AGENT][NEUTRAL] She has $500 for Thursday, then she will have $500 available for Friday then so on and so on each calendar day.
[CUSTOMER][NEUTRAL] Each calendar day. OK, OK, OK. OK. In the, in the sense, the patient will be covered, correct? OK.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] The primary and that's a maximum per calendar day. Nothing has been made so far. Thank you. Your name, ma'am? Your name is?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][POSITIVE] [PII]. Thank you, [PII].
[AGENT][NEUTRAL] You're welcome, [PII]. Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] Call reference number, um, you.
[CUSTOMER][NEUTRAL] No, that's you, you, you already provided. There is no authorizations required, by the way, right?
[AGENT][NEUTRAL] Correct, and we do not provide reference numbers either. You can use my name in today's date as reference.
[CUSTOMER][NEUTRAL] all the
[CUSTOMER][POSITIVE] Thank you. Your name is [PII], really. It's [PII], right? [PII] A.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] [PII], got it, got it. Thank you so much, [PII]. Have a nice day.
[AGENT][POSITIVE] Thanks for calling APL. Have a great one as well. Goodbye.
[CUSTOMER][NEUTRAL] You too.