AccountId: 011433970860
ContactId: 420019d6-6890-48dc-b7f2-e550f071745d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 128788 ms
Total Talk Time (AGENT): 56682 ms
Total Talk Time (CUSTOMER): 62938 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/420019d6-6890-48dc-b7f2-e550f071745d_20250103T18:09_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from um a physical therapy's office trying to verify potential benefits for a patient.
[AGENT][NEUTRAL] Sure, [PII], I could assist you with that. Can I have a callback number for you and that policy number?
[CUSTOMER][NEUTRAL] So it the callback number is [PII].
[CUSTOMER][NEUTRAL] And then as far as policy number I have an outpatient benefits cer cert number. Does that count?
[AGENT][NEUTRAL] Yes, either one of those numbers.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, so that number is 01699901 M as in Mary L as in Larry 8.
[AGENT][NEUTRAL] And [PII], could you verify that patient's name and date of birth that you're inquiring eligibility for?
[CUSTOMER][NEUTRAL] So the name is [PII] and her date of birth is [PII].
[AGENT][NEUTRAL] And you're calling to verify benefits eligibility for physical therapy.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Let me give you the correct policy number. Let me know when you're ready for it.
[CUSTOMER][POSITIVE] Yes please.
[AGENT][NEUTRAL] It is 247-3123.
[CUSTOMER][POSITIVE] Oh perfect OK.
[AGENT][NEUTRAL] This policy has been active since [PII] and is currently active. She has $300 per calendar day for outpatient services, and this is not a guarantee of benefits, just a disclaimer of the policy's coverage and physical therapy files under her outpatient benefits.
[CUSTOMER][NEUTRAL] OK, does it have anything to do with the fact that we're out of network?
[AGENT][NEUTRAL] This is a gap insurance. There is no network. We just, whatever the the primary put towards deductible, co-pay and co-insurance, then we will make a payment on it if services are covered under the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so, so, so in this specific situation if her primary denies it, then you will cover potentially 300 a day.
[AGENT][NEUTRAL] If we, if it went towards your deductible copay and co-insurance.
[CUSTOMER][NEUTRAL] Is that what I'm understanding?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect thank you so much.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Have a good day. Goodbye.
[CUSTOMER][POSITIVE] Thank you you too.