AccountId: 011433970860
ContactId: 36328edc-caf7-4b0f-a2da-3d1a1d980479
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 515799 ms
Total Talk Time (AGENT): 130776 ms
Total Talk Time (CUSTOMER): 119485 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/36328edc-caf7-4b0f-a2da-3d1a1d980479_20250416T13:14_UTC.wav
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[AGENT][NEUTRAL] For calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, I'm not working
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling to verify a patient's a benefits please.
[AGENT][NEUTRAL] OK, what is your name?
[CUSTOMER][NEUTRAL] I, I, I said my name is [PII].
[AGENT][NEUTRAL] OK, I didn't hear you, and did you say you're needing claim status or benefit information?
[CUSTOMER][POSITIVE] OK, no problem.
[CUSTOMER][NEUTRAL] I need benefits. I need out network benefits, please.
[AGENT][NEUTRAL] I'm sorry, what type of benefits?
[CUSTOMER][NEUTRAL] Out of network benefits for chirohysical therapy.
[AGENT][NEUTRAL] Is
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] And what's the policy number?
[CUSTOMER][NEUTRAL] It's 02595525.
[AGENT][POSITIVE] And a good call back number [PII] in case we're disconnected.
[CUSTOMER][NEUTRAL] 212-68268 2,126,826,620 thank you.
[AGENT][NEUTRAL] OK, give me just a second to pull up the file, OK?
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] And [PII], what's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII] and his date of birth is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. Showing an effective date of [PII], uh, this policy is active at this time.
[CUSTOMER][POSITIVE] You're welcome
[AGENT][NEUTRAL] And you said chiropractic and physical therapy?
[CUSTOMER][NEUTRAL] Acupuncture and foot orthotics for everything um out of network, please.
[AGENT][NEUTRAL] OK, so acupuncture is not covered. Um, I thought I heard physical therapy earlier. Was I incorrect?
[CUSTOMER][NEUTRAL] Yeah, yeah, no, physical therapy as well.
[AGENT][NEUTRAL] OK, so the acupuncture is not covered. Um, and did I hear you say chiropractic? That was the acupuncture? OK. Let me look and see if they have a
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] No, acupuncture is acupuncture is a different um service.
[AGENT][NEUTRAL] OK, so you are wanting [PII] as well, correct?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Still looking.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][POSITIVE] Good morning.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] That's one of the.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Would you be able to
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] OK. I don't show that physical therapy or uh is covered under the policy um for the chiro.
[AGENT][NEUTRAL] Uh, only manipulations are covered for chiropractic services, and there is an office visit benefit under this policy. One moment.
[CUSTOMER][NEUTRAL] I just, I just put it in for you I think.
[AGENT][NEUTRAL] And that benefit is up to $50 per day with a maximum of 4 days per calendar year per covered person.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And of course any information provided is verification, not a guarantee of payment. I'll check to see.
[AGENT][NEUTRAL] Uh, how many of those have been used, if any?
[CUSTOMER][NEUTRAL] OK, so wait, I just want, I just wanna repeat it, so it's up to $50 per day, up, up to 4 days. I'm sorry.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] $50 per day.
[AGENT][NEUTRAL] A maximum of 4 days per calendar year per covered person.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] Yeah, no worries.
[AGENT][NEUTRAL] That's for the Cairo visit manipulation only.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And then physical therapy?
[CUSTOMER][NEUTRAL] Alright
[AGENT][NEUTRAL] I'm sorry, there is a benefit for physical speech and occupational therapy. It's $30 per day.
[CUSTOMER][NEUTRAL] It's not
[AGENT][NEUTRAL] A maximum of 4 days per calendar year.
[AGENT][NEUTRAL] Now are you doing a PT in the [PII]'s office?
[CUSTOMER][NEUTRAL] Yeah, but it's different, um, it's different providers.
[AGENT][NEUTRAL] OK, so it's a licensed physical therapist?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, it has to be a licensed physical therapist. OK.
[AGENT][NEUTRAL] Any other questions?
[CUSTOMER][NEUTRAL] Um, do you have a deductible out of pocket?
[AGENT][NEUTRAL] No, this is a limited hospital indemnity plan.
[AGENT][NEUTRAL] And it just pays the benefits that you know were previously quoted.
[CUSTOMER][NEUTRAL] OK, so there's no like um um a reimbursement rate or anything like that?
[AGENT][NEUTRAL] It pays a certain dollar amount per day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, can I have a reference number?
[AGENT][NEUTRAL] It's gonna be my name in today's date, [PII], first initial last name is [PII].
[CUSTOMER][POSITIVE] OK thank you have a good day.
[AGENT][POSITIVE] All right, [PII], thanks for calling APL. Have a good day.