AccountId: 011433970860
ContactId: 5b5d6d71-aa32-4b19-97f8-2ab1c6763fb9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 577479 ms
Total Talk Time (AGENT): 171134 ms
Total Talk Time (CUSTOMER): 131859 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/5b5d6d71-aa32-4b19-97f8-2ab1c6763fb9_20250212T18:49_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling from ATI Physical Therapy to check on the benefits for the patient.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the benefits. And from my notes, can you spell your first name for me please and provide a good contact number?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][POSITIVE] Thank you for that. And your name, the spelling of your name?
[CUSTOMER][NEUTRAL] Thank you. [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] OK. And, may I have the member's policy number?
[CUSTOMER][NEUTRAL] D as in Delta 43728858.
[AGENT][NEUTRAL] Thank you for that. And do you have a copy of the member's ID card available?
[CUSTOMER][NEUTRAL] I'm not sure. Yes, I just have.
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] OK, on the card, do you see anywhere that says inhospital or outpatient policy certificate number?
[CUSTOMER][NEUTRAL] Let me check.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I could see that.
[CUSTOMER][NEUTRAL] MEC enhanced coverage.
[AGENT][NEUTRAL] Um, do you have the member's full social?
[CUSTOMER][NEUTRAL] No, we do not have the Social Security.
[AGENT][NEUTRAL] What's the member's first and last name?
[CUSTOMER][NEUTRAL] Member's first name is [PII] and the last name is [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] And, do you mind if I place you on just a brief hold while I try to locate the policy?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah, sure. And can I provide you the date of birth?
[AGENT][POSITIVE] And also what is the, yes, that's what I was asking for, yes. Thank you.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Alright, hold on one moment, OK?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh Lord.
[AGENT][NEGATIVE] That's not gonna help.
[AGENT][NEUTRAL] Hello, [PII].
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So, um, do you have a middle initial for her because there's several [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Yeah, let me check.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] We do not have any middle initial. It is [PII].
[AGENT][NEUTRAL] OK, um, do you know what state she's in?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] And do you mind if I place you on a brief hold?
[CUSTOMER][NEUTRAL] Go ahead, please.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Because
[AGENT][NEUTRAL] I have the information.
[AGENT][NEUTRAL] And she's in [PII].
[AGENT][NEUTRAL] Let's try.
[AGENT][NEUTRAL] Hey.
[AGENT][NEUTRAL] I I'm very shy.
[AGENT][NEUTRAL] That's what I'm talking about.
[AGENT][NEUTRAL] So her active medical policy is 7100.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] OK, hello, [PII]. Thank you so much for holding.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Alright, um, so I was able to find her on the first go. So the correct policy number is 237.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] 1130.
[AGENT][NEUTRAL] And that's for her medical policy, her hospital indemnity policy.
[CUSTOMER][NEUTRAL] Medical policy.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And just for the call, all the information provided is a verification of benefits, not a guarantee of payment.
[AGENT][NEUTRAL] And what questions did you have in reference to the benefits?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Physical therapy, which is done in office setting. Before that, can I know the patient's effective date and their mailing address to submit a claim?
[AGENT][NEUTRAL] The mailing address is [PII] I'm sorry, [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[AGENT][NEUTRAL] They have a payer ID as well. Would you like that?
[CUSTOMER][NEUTRAL] Yeah, go ahead, please.
[AGENT][NEUTRAL] OK, 645-56.
[CUSTOMER][NEUTRAL] OK, 645-5.
[CUSTOMER][NEUTRAL] And the effective date?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] The policy has been effective since [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] [PII]. And the policy number which is stated is 2,371,130.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, [PII], thank you. And can I know the patient's policy type?
[AGENT][NEUTRAL] So this is a hospital indemnity policy?
[CUSTOMER][NEUTRAL] That
[AGENT][NEGATIVE] And looking at the policy, there is no coverage for physical therapy.
[CUSTOMER][NEGATIVE] There is no physical therapy benefits for this patient that's not covered, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] So it is a plan your policy or in a calendar your policy?
[AGENT][NEUTRAL] Um, it depends on the benefits. Some are per day.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Per day.
[AGENT][NEUTRAL] Um, but overall it's per calendar year.
[CUSTOMER][NEUTRAL] So there is no physical therapy benefits coverage. Just a minute.
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, got it. Thank you. And uh I think I'm done with everything, and can I get the call reference number for this call?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] OK, got it. Thank you.
[AGENT][NEUTRAL] You're welcome, [PII]. Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] Nothing else. Have a great day. Thank you so much for assisting me today and have a wonderful day ahead. Bye-bye.
[AGENT][POSITIVE] You're [PII]ome and thanks for calling APL bye bye.
[CUSTOMER][NEUTRAL] Yeah bye bye.