AccountId: 011433970860
ContactId: 530eb9d9-f46d-40bb-8fdf-3a0c1ee38c39
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 372160 ms
Total Talk Time (AGENT): 110368 ms
Total Talk Time (CUSTOMER): 103732 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/20/530eb9d9-f46d-40bb-8fdf-3a0c1ee38c39_20250620T13:52_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Hi, good morning. I'm calling because I wanted to get a benefit for physical therapy um for a patient.
[AGENT][POSITIVE] Uh, I can help you with benefits. Who am I speaking with?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] Can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] And what's the policy number?
[CUSTOMER][NEUTRAL] Uh, OK, I have here 02061936. Mike Lima 8.
[AGENT][NEUTRAL] Give me just a moment.
[AGENT][NEUTRAL] Excuse me, sorry.
[CUSTOMER][NEUTRAL] Yeah, that's fine.
[CUSTOMER][POSITIVE] Bless you.
[AGENT][NEUTRAL] Can I get you to verify the patient's name and date of birth for me, please?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] And the date of birth, [PII].
[AGENT][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] Let me see here.
[CUSTOMER][NEUTRAL] Uh, just, I'm not sure if that's the correct policy number. I mean, I'm looking at it on the card and it says outpatient benefit cert number.
[AGENT][NEUTRAL] Uh, yes, that was the right one. however, so, um, that policy had lapsed, but she does have a new, uh, active policy with us. Would you like that number?
[CUSTOMER][NEUTRAL] If not, I do. Oh, OK, OK, OK.
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Is it the [PII]?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, alright, so yeah, I have that.
[AGENT][NEUTRAL] Yeah, that's, that's the new one that has an effective date of [PII].
[AGENT][NEUTRAL] And let me look at their policy and you said for physical therapy, correct?
[CUSTOMER][NEUTRAL] Uh, yes, physical therapy in an outpatient hospital setting.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me check.
[AGENT][NEUTRAL] This is just a verification of benefits, not a guarantee of payment. I am showing that physical therapy is covered if it's in a physical therapy facility.
[AGENT][NEUTRAL] With a maximum of it looks like 30 days of treatment per calendar year.
[AGENT][NEUTRAL] They have an outpatient benefit maximum of up to $3500 per calendar year.
[AGENT][NEUTRAL] Let me just double check.
[AGENT][NEUTRAL] It looks like that would be considered an outpatient facility, uh, so physical therapy.
[AGENT][NEUTRAL] Could be covered and I'm just double checking.
[AGENT][NEUTRAL] I'm just showing that physical therapy is covered if it's performed in a physical therapy facility.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I don't know if that pertains to, to your hospital, if it's a physical therapy facility just on site or if it's in the actual hospital.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] They have it as an outpatient hospital, so, um, I'll get, I guess, better clarification to see if that falls into it. Um, out of the 3500, uh, has anything been used?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me check.
[AGENT][NEUTRAL] It looks like they have only used $910 of that so far.
[CUSTOMER][NEUTRAL] OK, and then you said that it covered up to 30 visits, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] What was my next question.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I mean, oh well, uh, if, I mean, I'm gonna, like I said, clarify if we do fall under the facility, but how you say that they cover uh up to 3500, that includes copays and all that stuff, right?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Co-insurance and co-deductible, yes, ma'am.
[CUSTOMER][NEUTRAL] Yeah, OK, perfect. Alrighty, um, so I'll get clarification, um, would you be able to provide me a reference number for this call?
[AGENT][NEUTRAL] So we don't have reference numbers you can use my name and last initial in today's date, so [PII] and then today's date.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][POSITIVE] Alrighty thank you so much for your help.
[AGENT][POSITIVE] Alright, thank you for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Mhm