AccountId: 011433970860
ContactId: 53529d6e-b61e-4306-8108-a6032b77ce35
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 235279 ms
Total Talk Time (AGENT): 87970 ms
Total Talk Time (CUSTOMER): 86978 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/02/53529d6e-b61e-4306-8108-a6032b77ce35_20250602T18:56_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hey, how's it going? I had a question about patients uh benefits real quick.
[AGENT][NEUTRAL] OK, I can verify benefits for you. And your name is?
[CUSTOMER][NEUTRAL] Uh, my name is [PII].
[AGENT][NEUTRAL] [PII]?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK, and what's that policy number, please?
[CUSTOMER][NEUTRAL] Uh, policy number is 02596156.
[AGENT][POSITIVE] OK, thank you so much. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] OK, and the patient's name, date of birth?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, thank you. And you say you have questions in regards to benefits, correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, and what questions do you have?
[CUSTOMER][NEUTRAL] Um, so the patients coming to our office for outpatient services.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Like physical therapy and chiropractic care, since this is a hospital indemnity plan, would she get any benefits through this plan at all, or does she have to be admitted into a hospital inpatient stay?
[AGENT][NEUTRAL] Uh, no, they have outpatient benefits, but it's for sickness and it's either for services performed in the physician's office, um, urgent care or ER.
[AGENT][NEUTRAL] But, uh, and
[CUSTOMER][NEUTRAL] So, so we are an office.
[AGENT][NEUTRAL] OK. So an office is covered if it's in the diagnosis in regards to a sickness, but as far as physical therapy, uh, it's not covered under the plan.
[CUSTOMER][NEUTRAL] So what do you mean by like sickness? Could, could I give you a uh a CB, uh, a diagnosis code and you can tell me yes or no.
[AGENT][NEUTRAL] OK, what's the diagnosis code?
[CUSTOMER][NEUTRAL] M 9901.
[CUSTOMER][NEUTRAL] I want to try that one first.
[AGENT][NEUTRAL] Uh, that would be considered a sickness. It's not, uh, an accident or bodily injury.
[CUSTOMER][NEUTRAL] So it would be?
[AGENT][NEUTRAL] That would be covered as a sickness.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, and so would you get any benefits for chiropractic manipulations?
[AGENT][MIXED] Uh, not for manipulations, but I do have benefits for an office visit.
[CUSTOMER][NEUTRAL] Uh, how much, uh, yeah, what, what do we get for an office visit?
[AGENT][NEUTRAL] Um, not a guarantee of payment, just a verification coverage. Uh, the max benefit is $75 per day, and they have a total of 5 visits per year.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] So you, you all will pay out $75 a day uh for for a total of 5 visits a year.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Cool.
[CUSTOMER][NEUTRAL] Um, OK, uh, and then has she used any of these visits?
[AGENT][NEUTRAL] Uh, I see.
[AGENT][NEUTRAL] Uh, no, she hasn't, so it is available.
[CUSTOMER][NEUTRAL] Cool. And then is this a calendar year benefit or does it renew on [PII] when the plan became effective?
[AGENT][NEUTRAL] It's a calendar year.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Alright, um, awesome I think that is all the information I needed, uh, if I could just get a reference number or something that'd be great.
[AGENT][NEUTRAL] Uh, if you like, you may use my name at today's date.
[CUSTOMER][NEUTRAL] What was your name?
[AGENT][NEUTRAL] It's [PII] last initial [PII]
[CUSTOMER][POSITIVE] Cool.
[CUSTOMER][POSITIVE] Thank you [PII], hope you have a great day.
[AGENT][POSITIVE] Oh, you too, thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] Bye.
[AGENT][NEUTRAL] Bye.