AccountId: 011433970860
ContactId: 5942f96b-9b43-4a6e-a7c3-bf22ae97880d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 248020 ms
Total Talk Time (AGENT): 104798 ms
Total Talk Time (CUSTOMER): 91783 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/5942f96b-9b43-4a6e-a7c3-bf22ae97880d_20250211T16:28_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello [PII], my name is [PII] and I wanted to check that benefit insurance for my patient.
[AGENT][NEUTRAL] Yeah, we just needing to check to see if that's still uh active.
[CUSTOMER][NEUTRAL] Mhm. And, and what the benefits are, yeah, like what the coverage is, I should say. Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, we can check on that.
[AGENT][NEUTRAL] Of course. Alright, and then, uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII], no extension.
[AGENT][NEUTRAL] Thank you. And do you have that policy number?
[CUSTOMER][NEUTRAL] I do, yes. I have 01861194, M for Mike, L for Lima, 8.
[AGENT][NEUTRAL] OK, thank you and what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] I have [PII] [PII].
[AGENT][NEUTRAL] Perfect, thank you for verifying that, [PII]. Uh, so this policy is active. Effective date was [PII].
[AGENT][NEUTRAL] And was this for uh outpatient?
[CUSTOMER][NEUTRAL] Uh, it's for outpatient, but, um, physical therapy.
[AGENT][NEUTRAL] Physical therapy, OK. Give me just a moment. Let me make sure that that is a covered benefit under this policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, appreciate your patience. um, so of course I will let you know verification of coverage is not a guarantee of payment for claims. So, uh, physical therapy performed in a physical therapy facility is going to be covered under their outpatient benefits and the outpatient benefit pays on a per calendar day basis, so it is uh $500 max per calendar day.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and then the outpatient facility is that including also a hospital?
[AGENT][NEUTRAL] Uh, physical therapy.
[CUSTOMER][NEUTRAL] Because the patient is coming to the hospital, yeah, to the hospital to get it done, but as a patient, uh-huh.
[AGENT][NEUTRAL] For the physical therapy?
[AGENT][NEUTRAL] It does specify physical therapy performed in a physical therapy facility.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK. Um, so that, that's actually confusing to me. I'm so sorry, um, because the hospital is a hospital.
[AGENT][NEUTRAL] It's OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is that in the outpatient facility, is the hospital under that category for you guys?
[AGENT][NEUTRAL] They do have treatment covered.
[CUSTOMER][NEUTRAL] Because I don't know of any outpatient facilities.
[AGENT][NEUTRAL] Sorry, go ahead.
[CUSTOMER][NEUTRAL] No, cause I don't, I don't know what a um physical therapy facility is.
[AGENT][NEUTRAL] Uh, a physical therapy facility, essentially, that's all that they do there is the physical therapy.
[CUSTOMER][NEUTRAL] And that is the only thing that is covered then.
[AGENT][NEUTRAL] That's what's specified for the physical therapy benefit, yes. So, other facilities are covered with surgeries, uh, diagnostic testings, things like that, or treatment received.
[CUSTOMER][NEUTRAL] Those facilities.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So it's not covered at the hospital.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] In like a hospital facility.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so then let me just document here that the patient is not covered at the hospital.
[CUSTOMER][NEUTRAL] OK, what's the reference number for this call?
[AGENT][NEUTRAL] It would just be my first name, last initial, and today's date. Uh my name is spelled [PII] And was there anything else I can help you with, [PII]?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Uh no, that'll be all. Thank you.
[AGENT][POSITIVE] OK, yep, thanks for calling APL. Have a great rest of your day.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Mhm mhm mhm mhm.