AccountId: 011433970860
ContactId: 396868d7-3d59-49c4-a52a-f3d02c48cd5e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 270839 ms
Total Talk Time (AGENT): 97458 ms
Total Talk Time (CUSTOMER): 67647 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/396868d7-3d59-49c4-a52a-f3d02c48cd5e_20250424T17:30_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, um, I'm calling cause I needed to get uh eligibility and benefits on a patient.
[AGENT][NEUTRAL] OK, I can check eligibility and benefits for you. Um, what was your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure it's [PII].
[AGENT][NEUTRAL] Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Yes, the policy number.
[CUSTOMER][NEUTRAL] It's 02564467 Mike Lima 8.
[AGENT][NEUTRAL] OK, and then uh what was the name and date of birth for the member, please?
[CUSTOMER][NEUTRAL] The date of birth is [PII], and the name is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, got it thank you for verifying all of that.
[CUSTOMER][NEUTRAL] You, yeah.
[AGENT][NEUTRAL] So, uh, this policy is active. Effective date was [PII], and this is a secondary medical policy, so it is designed to help with co-pay, deductible and co-insurance after major medical pays, and we really need to look at inpatient or outpatient benefits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's inpatient and the benefit is for physical therapy.
[AGENT][NEUTRAL] It's inpatient physical therapy?
[CUSTOMER][NEUTRAL] Oh, I, I apologize actually, wait, hold on. It's um physical therapy in an outpatient hospital setting.
[AGENT][NEUTRAL] OK, I was kind of confused. All right.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just a moment like I've never heard of that. Um, alright, give me just a moment, let me see if that is a covered benefit.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Bear with me just a moment. I appreciate your patience.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, um, I really appreciate your patience. Thank you. Um, so physical therapy performed in a physical therapy facility is covered under their outpatient benefits and of course I will let you know verification of coverage is not a guarantee of payment for claims. So that outpatient benefit on this policy is on a per calendar day basis, so it pays up to $1500 max per calendar day. There is no yearly maximum.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Cover under. OK, perfect. So they will cover, OK, um, and I'm sorry, what was your name again?
[AGENT][NEUTRAL] OK it's [PII]
[CUSTOMER][NEUTRAL] Alright, OK, perfect. And would you be able to provide a reference number for the call?
[AGENT][NEUTRAL] Yeah, that would just be my first name, last initial, and today's date, um, so my last initial is [PII] and was there anything else I could help you with?
[CUSTOMER][NEUTRAL] Uh, no, that was all.
[AGENT][POSITIVE] Alright, well thanks for giving us a call and I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you bye bye.