AccountId: 011433970860
ContactId: 53245112-5e22-4a41-bf47-ab5e387c4a6f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 325679 ms
Total Talk Time (AGENT): 122627 ms
Total Talk Time (CUSTOMER): 85007 ms
Interruptions: 0
Overall Sentiment: AGENT=1.9, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/53245112-5e22-4a41-bf47-ab5e387c4a6f_20250206T14:46_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi, I'm [PII] from Avand Therapy Center. I'm calling in regards to, um, outpatient of physical and and occupational therapy benefits.
[AGENT][NEUTRAL] OK, [PII], you're needing to see if there are physical therapy and occupational therapy benefits. Is that correct on a member's plan?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][POSITIVE] Yes, I can help you with that. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] Let me see the members um uh policy 024.
[CUSTOMER][NEUTRAL] 24
[CUSTOMER][NEUTRAL] 712 M as in Mary, L as in Lima 8.
[AGENT][NEUTRAL] OK thank you one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And any information that I do provide for you today, [PII] would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] [PII], date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, so you did not need eligibility only benefits, is that correct?
[CUSTOMER][NEUTRAL] Uh, both will be better.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, so he is a subscriber on the supplemental policy and it is active with an effective date of [PII].
[AGENT][NEUTRAL] Um, one moment while I get his benefit information pulled up please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so under this policy, is this gonna be done in a freestanding facility or within an office setting?
[CUSTOMER][NEUTRAL] Uh for starting.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, so on his policy, uh, this would not be covered in an office setting.
[CUSTOMER][NEUTRAL] OK, so neither physical or occupational therapy?
[AGENT][NEUTRAL] Covered in an office setting. No, ma'am, if it was in a freestanding uh for physical therapy and a freestanding, you know, facility, then yes, there would be benefits. However, occupational therapy is not covered.
[CUSTOMER][NEUTRAL] OK, give me 1 2nd.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, so in office setting neither are are covered then and what did you say your name is?
[AGENT][NEUTRAL] [PII], and you would use the first initial to my last name if you need a call reference number and then should you all end up filing a claim, [PII], on this policy, we will also have to have a copy of the primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] And then we do have a portal in which our claim status can be checked by going to [PII].
[CUSTOMER][NEUTRAL] I mean we're not gonna be, I mean we're not gonna be um filing a claim since it's not covered in an office setting and that's that's the only way we can bill.
[AGENT][NEUTRAL] Yes, ma'am, but this is something, yes, this is something that we have to disclose to you.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] And you said uh your name is [PII] and what was the last, the initial of your last name?
[AGENT][NEUTRAL] Yes and yours?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Could I please have a reference number, [PII]?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Again, it would be my name in today's date.
[CUSTOMER][POSITIVE] Uh, OK, thank you, thank you very much for your help.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] Yes, ma'am. You're certainly welcome. So that's all I can help you with. Thank you again for calling APO and I hope you have a nice day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you. Bye-bye.