AccountId: 011433970860
ContactId: 378163c9-78c1-4026-9fee-82f5ac164433
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 346959 ms
Total Talk Time (AGENT): 120199 ms
Total Talk Time (CUSTOMER): 61653 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/378163c9-78c1-4026-9fee-82f5ac164433_20250224T18:10_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from orthopedic rehab specialist. Um, a patient, uh, let us know that they had APL as their secondary insurance, so I'm just wondering what it covers to when it comes to physical therapy done in an office setting.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK [PII], so you're needing eligibility and benefit information for a member, is that correct?
[CUSTOMER][POSITIVE] Yes correct.
[AGENT][POSITIVE] Yes, ma'am. I can help you. And what is your callback number?
[CUSTOMER][NEUTRAL] Uh, our callback number is [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] Uh, the number is 02519291.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] OK, and any information that I do provide for you today, and it would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] The patient's name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you. One moment.
[AGENT][NEUTRAL] OK, so he is the subscriber on the supplemental policy, [PII], and it is active with an effective date of [PII].
[AGENT][NEUTRAL] And on this policy, um,
[AGENT][NEUTRAL] Is this gonna be done in an office setting or in a facility?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Uh, in an office setting.
[AGENT][NEUTRAL] OK, so give me just a moment to check the benefits for that, please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Well, bear with me and I'm gonna have to open up one of my screens again.
[CUSTOMER][NEUTRAL] Oh I see
[AGENT][NEUTRAL] OK, so on this supplemental policy, Amy, there are not benefits.
[AGENT][NEUTRAL] Well, give me just, let me look at one additional thing.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK. So, yes, on this supplemental policy treatment.
[AGENT][NEUTRAL] In the office, in an office setting is not a covered benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right thank you so much.
[AGENT][POSITIVE] Yes, ma'am. Well, you're certainly welcome. So again, is there anything else that I can help you with?
[CUSTOMER][NEUTRAL] Uh, no, that was it. Um, could I just get a reference number if there is one?
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes ma'am, you would actually use my name along.
[AGENT][NEUTRAL] Of today's date.
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Oh, it's your name?
[AGENT][NEUTRAL] And again my name
[AGENT][NEUTRAL] Yes, ma'am. Could you hear me?
[CUSTOMER][NEUTRAL] You were cutting in and out. It's your name and the and today's date?
[AGENT][NEUTRAL] Yes ma'am, uh huh, it is. And should you all end up filing a claim with APL, then we would also have to have a copy of the primary insurance company's explanation of benefits as well, [PII]. And then also, um, once we've processed the claim, we do have a portal in which you can check claim status by going to [PII].
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] OK. Well, you are certainly so welcome. So if that is all I can help you with, then thank you again for calling APL and I hope you have a very nice afternoon.
[CUSTOMER][POSITIVE] Alright you have a great afternoon as well.
[AGENT][POSITIVE] Yes, ma'am. Thank you.
[CUSTOMER][NEUTRAL] All right bye bye.
[AGENT][NEUTRAL] Bye bye.