AccountId: 011433970860
ContactId: 3705498e-533d-4dfb-bb1d-6185bd508849
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 171660 ms
Total Talk Time (AGENT): 115897 ms
Total Talk Time (CUSTOMER): 39670 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/3705498e-533d-4dfb-bb1d-6185bd508849_20250414T13:18_UTC.wav
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[AGENT][NEUTRAL] Contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] So the provider I'm calling to get benefits for a member, please.
[AGENT][NEUTRAL] I can help with benefits and I'm sorry I didn't catch your name.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And [PII], what is that policy number that we're looking at today?
[CUSTOMER][NEUTRAL] I have 962-8887.
[AGENT][NEUTRAL] 87, thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] I have [PII] um Oea [PII].
[AGENT][POSITIVE] OK, thank you very much.
[AGENT][NEUTRAL] And while I'm looking that up, if I could just have a callback number please in the event that we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. The policy went into effect on [PII]. It is active. [PII] is active on this policy. Um, now you mentioned benefits, uh, this policy picks up the deductible. Yes, uh-huh. Well, what it does, [PII] is it.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] But does it cover
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK, go ahead.
[AGENT][NEUTRAL] Oh, well, I was just gonna say it picks up the deductible, co-payment or co-insurance for in and out of hospital visits, as well as um the co-pay for the physician's office. Um, she has 4 of those throughout the calendar year.
[CUSTOMER][NEUTRAL] Does it cover, does it cover physical therapy, rehab because I know some policies do not cover um rehab, physical therapy or?
[AGENT][NEUTRAL] Yeah, I think this one actually does. Um, let me just check here really quickly because I'm, I'm pretty certain that it does cover it, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] See if I can't
[AGENT][NEUTRAL] Go back to here up.
[AGENT][NEUTRAL] I don't know what to do.
[AGENT][NEUTRAL] Usually these enhanced policies do cover physical therapy, so this wouldn't be absolutely certain about that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, now if it does, of course, as I mentioned before, it is a secondary insurance, and so what we'll do is we will, you'll file it through their major medical first and then through so let's see what we've got here.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] Yeah, I think it's I should have guessed. OK, so yeah, the, these, uh, these particular policies do cover the physical therapy. Now, what the um
[AGENT][NEUTRAL] The benefits are is that for outpatient services such as this, we'll pick up the deductible, co-payment or co-insurance which is $3000 per calendar year. That's just a verification benefits, not a guarantee of payment, and it doesn't look, I think [PII] has probably used about $200 of her benefits so far about $3000.
[CUSTOMER][POSITIVE] 200 perfect thank you so much for that and can I get um.
[AGENT][POSITIVE] Yeah, great.
[CUSTOMER][NEUTRAL] A reference number?
[AGENT][NEUTRAL] Yes, um, certainly. My name is [PII]. The first letter of my last name is [PII]. We use that today's date as a reference. Is there anything else at all that I can help with?
[CUSTOMER][POSITIVE] That'll be all thank you so much for helping you have a great day.
[AGENT][POSITIVE] OK. Thanks for contacting you have a