AccountId: 011433970860
ContactId: 47287bf5-fd6a-4a2c-ba71-1579d69001ac
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 212919 ms
Total Talk Time (AGENT): 55579 ms
Total Talk Time (CUSTOMER): 125998 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/25/47287bf5-fd6a-4a2c-ba71-1579d69001ac_20250625T20:42_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, uh, I have a question on my coverage, uh.
[CUSTOMER][NEUTRAL] I have an APL as a secondary insurance, and
[CUSTOMER][NEUTRAL] My, uh, my doctor before I, I have a tear on my shoulder. He actually sent me to physical therapy before, you know, see if that would help, uh, in the meantime while they were doing the MRI, uh, and I want to know what I'm covered for because, you know, at the risk department here at the city, uh, they gave me some information, but I just wanna make sure I don't go ahead. Uh, I've actually done 4 visits.
[CUSTOMER][NEUTRAL] Uh, but I don't know if there's a limit on that because more than likely I'm going to have
[CUSTOMER][NEUTRAL] You know, if they end up doing the surgery, which I suspect that they will, I'm gonna have a real physical therapy afterwards. Uh, this one is sort of like preventive. I'm not sure that this is gonna work, but anyways, I just wanna know what my limit is.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, do you have your policy number?
[CUSTOMER][NEUTRAL] Uh, they said the, not the group number you actually want the individual coverage.
[AGENT][NEUTRAL] Uh yes, it should be.
[CUSTOMER][NEUTRAL] Uh, payer ID, you know.
[AGENT][NEUTRAL] A policy certificate number?
[CUSTOMER][NEUTRAL] Group number is 154 sorry?
[AGENT][NEUTRAL] Uh, there should be a certificate number.
[CUSTOMER][NEUTRAL] Certificate number certificate number.
[AGENT][NEUTRAL] Policy certificate number.
[CUSTOMER][NEUTRAL] Yeah, uh, out outpatient certificate number.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] 02616623 Mike [PII] 8
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, can you verify your name and date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII], [PII].
[AGENT][NEUTRAL] Hey, Mr. [PII], can you verify your address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. Uh, let me pull up your policy and see what your benefits are. Um, anything I quote is not a guarantee of payment. It's a basic outline of your policy.
[AGENT][NEUTRAL] Um, let me see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so yes, this is a secondary policy and for your benefits for physical therapy.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] You have an outpatient benefit of 7900 per calendar year.
[AGENT][NEUTRAL] That's the, that's the most it will pay in calendar year after your primary processes, the claim will pay up to that amount. There's no visit limit, it's just the dollar amount.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK, alright.
[CUSTOMER][NEUTRAL] Yeah, I, I'm, I'm nowhere near that. Yeah, I just didn't know if that was, uh, you know, I, for some reason someone in the risk department mentioned that, oh, there might be like a visit limit, and I was like, oh, OK, well, you know, because I, and I, and I doctors tend to do this. They send you to physical therapy just in case, uh, see if it works even though I have a tear, so I don't think that's gonna work, but, uh, you know, I'm like, I, I'm not gonna be paying all this money, you know, it's I think it's like $50 it's gonna end up being like 20 to $300.
[CUSTOMER][NEGATIVE] You know, if I, this is not gonna do anything, but I wasn't sure how it worked.
[AGENT][NEUTRAL] Sure, yeah, I understand.
[CUSTOMER][NEUTRAL] So it's it's per policy, no, no, not per business alright.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] OK, thank you very much that answers my question.
[AGENT][POSITIVE] OK, thank you for calling APL. Have a good afternoon.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you, bye-bye. Bye