AccountId: 011433970860
ContactId: 5456f803-e579-4888-b00a-bea19662f638
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 199740 ms
Total Talk Time (AGENT): 132309 ms
Total Talk Time (CUSTOMER): 58221 ms
Interruptions: 1
Overall Sentiment: AGENT=2.5, CUSTOMER=2.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/5456f803-e579-4888-b00a-bea19662f638_20250113T20:52_UTC.wav
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[AGENT][POSITIVE] Good Afternoon. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hi, I'm just needing help with the patient's eligibility and benefits.
[AGENT][POSITIVE] Yes, ma'am. I'll be glad to help you. Go ahead and give me your name and the member's policy number, please.
[CUSTOMER][NEUTRAL] Yes, my name is [PII]. Last initial is [PII] member's policy number is 02370344 M as in Mike L as in Lima 8.
[AGENT][POSITIVE] Alrighty thank you so much for all that information, [PII]. Now while I'm pulling this up, go ahead and give me a good return telephone call number.
[CUSTOMER][NEUTRAL] OK, it's [PII].
[AGENT][NEUTRAL] Alrighty [PII], thank you for all that information. Now, what is your patient's name and date of birth today please ma'am?
[CUSTOMER][NEUTRAL] Uh, [PII], [PII].
[AGENT][NEUTRAL] All right, thanks [PII] for that information. Looks like [PII] is the insured on this medical supplemental plan. They show the original effective date as cuse me, [PII] current policy is active, but I must advise that verification of coverage is not a guarantee of payment on the claim, but you did say you want some type of benefit. Is that correct?
[CUSTOMER][NEUTRAL] Uh yes, please.
[AGENT][POSITIVE] Yes ma'am. What type of benefit are you needing today?
[CUSTOMER][NEUTRAL] Uh, physical therapy.
[AGENT][NEUTRAL] Alrighty, let's see.
[AGENT][NEUTRAL] Well, I do show that this patient has already maxed out the entire benefit for 2024, but let me see, 2025. OK, for outpatient um physical therapy, it's gonna have a no pre-cert.
[AGENT][NEUTRAL] And no deductible, and they have a $5000 benefit payable for outpatient, which we consider uh physical therapy outpatient benefits. But of course we are just a medical supplemental plan. So of course that would be only for sickness and injury. Nothing routine here is covered at all, and it has to apply towards patients deductible, co-pay or co-insurance, and that is what we would pick up and pay.
[CUSTOMER][POSITIVE] OK perfect and I'm sorry it was for sick sickness and injury, not for what? Like maintenance care?
[AGENT][NEUTRAL] Not for, no, yeah, right, not for wellness, for sickness and injury only, yes ma'am, has that $5000 max payable per calendar year and he's not made any for [PII] yet.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK perfect and then you guys cover 100% from the primary whether it's deductible, co-insurance, or co-pays just up to that maximum.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] That is correct and it has to apply towards their deductible copay or co-insurance. If it's not covered by the primary, it's not covered here.
[CUSTOMER][POSITIVE] OK perfect that makes sense thank you so much and if I could just get a reference number.
[AGENT][NEUTRAL] Yes, ma'am. OK, well.
[AGENT][NEUTRAL] Well, [PII], we don't give reference numbers, but you can use my name in today's date if you need to do so, and is that all I can help you with today?
[CUSTOMER][POSITIVE] Yes, thank you so much.
[AGENT][POSITIVE] Alrighty, [PII], yes, ma'am, and thank you for calling APL. You have a great rest of your day.
[CUSTOMER][POSITIVE] You too. Thanks. Bye.
[AGENT][POSITIVE] Thank you, ma'am. Bye bye.