AccountId: 011433970860
ContactId: 508c96a4-bd4d-4268-b462-314221282b32
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 375940 ms
Total Talk Time (AGENT): 195283 ms
Total Talk Time (CUSTOMER): 153339 ms
Interruptions: 3
Overall Sentiment: AGENT=0.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/17/508c96a4-bd4d-4268-b462-314221282b32_20250117T17:26_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I'm meaning to verify outpatient hospital based physical therapy benefits for a patient.
[AGENT][POSITIVE] OK, I can help you with physical therapy benefits. Can you please give me your name and your callback number?
[CUSTOMER][NEUTRAL] Sure, my name is [PII] and the callback number here is [PII].
[AGENT][NEUTRAL] OK, thank you [PII] and then what is the patient's name?
[CUSTOMER][NEUTRAL] It's for [PII].
[AGENT][NEUTRAL] And what is [PII]'s date of birth?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] And his policy number, please?
[CUSTOMER][NEUTRAL] It's 02236700.
[AGENT][NEUTRAL] OK, let me pull in that policy real quick.
[AGENT][NEUTRAL] OK, I do show that [PII] does have an active policy with us. His effective date is [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I'm going to need to pull in his policy and read it, uh, to find out about the physical therapy benefits.
[AGENT][NEUTRAL] But his outpatient and this is just to verify his coverage, it's not a guarantee of payment his outpatient benefits are um.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] $5000 per calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then let me get that policy pulled in.
[CUSTOMER][NEUTRAL] my
[CUSTOMER][NEUTRAL] OK, yeah, I do know that it's a secondary policy.
[AGENT][POSITIVE] Yes ma'am, yes ma'am, it helps with deductible co-pay and co-insurance.
[AGENT][NEUTRAL] And of course my computer is being a little slow at pulling it in but it's coming.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] It's Friday and it's cold out, so yeah, I think.
[AGENT][NEUTRAL] Right, yes.
[AGENT][NEUTRAL] Where are you at?
[AGENT][NEUTRAL] You said it's cold outside. where are you guys, where are you from?
[CUSTOMER][NEUTRAL] Uh, [PII] [PII], we had probably, uh, last week about 12 inches of snow. It's still, like, hopefully it's, it's been so cold, so it's like things just aren't melting.
[AGENT][NEUTRAL] Oh,
[AGENT][POSITIVE] Oh my gosh.
[AGENT][NEGATIVE] Oh gosh. So it's just all out there and it's turning into yuck and muck.
[CUSTOMER][NEUTRAL] Oh yeah, that's like, you know what he's refreezing and.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] She was the uh
[AGENT][NEUTRAL] And I'm in [PII].
[AGENT][NEUTRAL] And we're supposed to get snow. [PII] doesn't get snow hardly ever, but we're supposed to get snow on Tuesday.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEGATIVE] And everybody's freaking out because it's gonna be a dusting.
[CUSTOMER][NEUTRAL] Well, yeah, I mean, well, even here though, we would think we would be better equipped for snow, but we are not around here, so.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, I grew up in [PII], so I'm used to the snow, you know, in, but.
[CUSTOMER][POSITIVE] Oh, then you're a pro then.
[AGENT][NEUTRAL] Yeah, but I here they don't, they don't have the preparation for the roads and stuff like they do, you know, when you get snow all the time, I just keep my little self at home.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh yeah, I mean [PII] yeah they're, they're known for equipped and.
[AGENT][NEUTRAL] Right, right. OK. I have found physical therapy.
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][NEUTRAL] And um the facilities that it can be, he, he does have physical therapy and uh in an office center or a clinic in which a licensed physical therapist provides physical therapy.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, so we're an outpatient hospital facility.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] I don't know if that changes.
[AGENT][NEUTRAL] Yeah, that would be, that would be an office or a center, I would think an office or a center or clinic.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Are the 3 facilities.
[CUSTOMER][NEUTRAL] right now.
[AGENT][NEUTRAL] Yeah
[AGENT][POSITIVE] So he does have benefits for the physical therapy.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And he'll be, he'll be under that outpatient benefit of.
[CUSTOMER][NEUTRAL] I apologize ma'am. I couldn't hear you. Can you please repeat that?
[AGENT][NEUTRAL] Yes, ma'am. He does have physical therapy benefits and he'll be under that outpatient uh benefit amount of $5000 per calendar year.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, so the deductible.
[AGENT][NEUTRAL] The outpatient deductible.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] and if there's any I know.
[AGENT][NEUTRAL] For accident or sickness, he has a deductible for accident or sickness of $1000 calendar year.
[CUSTOMER][NEUTRAL] OK OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] But I guess the 5000 that's just for the PT benefits and once he's that.
[AGENT][NEUTRAL] Right. And the policy actually
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] They they uh.
[AGENT][NEUTRAL] Covers for deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK, alright.
[CUSTOMER][NEUTRAL] And then is there any, I am so sorry I can't hear you, ma'am. um is there any kind of visit limits? No, OK, alright, perfect. Alright, and then I think I have, I just need if I get a reference number for the call then we should be good.
[AGENT][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] It's
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Yes ma'am, you can use my name [PII] and today's.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] In today's date, OK, perfect. Alright, [PII], I appreciate all of your help. Thank you very much.
[AGENT][POSITIVE] You're welcome, [PII]. You have a great weekend and thanks for calling APL.
[CUSTOMER][POSITIVE] Alright you too thank you bye.
[AGENT][NEUTRAL] Bye