AccountId: 011433970860
ContactId: 5b6fcc1a-e615-4427-b740-90b640a8bba4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 320769 ms
Total Talk Time (AGENT): 128967 ms
Total Talk Time (CUSTOMER): 111285 ms
Interruptions: 3
Overall Sentiment: AGENT=0.4, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/5b6fcc1a-e615-4427-b740-90b640a8bba4_20250319T12:55_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] But they're also
[CUSTOMER][NEUTRAL] Hi [PII], it's [PII] calling from Tenant Florida physician Services. I'm not sure if I clicked the right, um, prompt, but I was just calling to see if I can get like benefits for a patient.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK. Spell your first name for me.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Exactly
[CUSTOMER][POSITIVE] Yes, you got it.
[AGENT][NEUTRAL] OK, and you said eligibility and did you say is this in an office setting or outpatient facility?
[CUSTOMER][NEUTRAL] It's an office setting.
[AGENT][NEUTRAL] OK, what's the policy number and a good uh callback number, [PII]?
[CUSTOMER][NEUTRAL] Uh, callback number is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and you need a policy is um it's 251-813-9.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] I didn't even know.
[CUSTOMER][NEUTRAL] Right
[AGENT][NEUTRAL] Verify the patient's name and date of birth for me please.
[CUSTOMER][NEUTRAL] It's [PII], last name [PII].
[AGENT][NEUTRAL] Thank you for that information, [PII]. So I have the effective date for you, um, which is [PII]. The policy is currently active, and then we're looking for office visit benefit. Let me pull up that information.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, so the physician fee or the office visit co-pay is not covered, but covered treatment in the office can be considered under the outpatient benefit.
[CUSTOMER][NEUTRAL] Well, actually I'm calling for physical therapy, like outpatient physical therapy done in a specialist office.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, thanks for the specifics. Let me see if physical therapy is covered.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] OK, so I do show that uh physical therapy is a covered item under the outpatient benefit and that calendar year maximum, it's actually a plan year maximum is up to $2,025.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's per covered person per plan year.
[AGENT][NEUTRAL] And of course any information provided is verification, not a guarantee of payment, and I'll check to see if any of that information or benefit has been used at this time.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, I'm not showing any of the outpatient benefit used at this time.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] $40
[CUSTOMER][NEUTRAL] OK, so they can use up to like $2,025 for physical therapy then that what goes towards like a co-pay or any kind of um.
[AGENT][NEUTRAL] So it's not specific. This benefit is not specific to physical therapy, it's any outpatient service. Physical therapy falls under outpatient and it's up to $2,025 per covered person per plan year and it's for any charges, covered charges applied towards the major medical deductible, co-insurance and or or co-pay amounts.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] And then mhm OK.
[CUSTOMER][NEUTRAL] So any outpatient service.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I I don't know you do know.
[AGENT][NEUTRAL] Does that make sense?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Per person per person.
[AGENT][NEUTRAL] For plan year.
[CUSTOMER][NEUTRAL] Per pioneer.
[CUSTOMER][NEUTRAL] I'm just writing.
[AGENT][NEUTRAL] You're fine.
[CUSTOMER][NEUTRAL] OK, and that will go towards any like copay, co-insurance or anything that's left over from the primary insurance basically.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I guess we're saying the same thing, yeah, so yeah, the primary deductible co-insurance and or co-pay amounts is what this policy will review for a benefit.
[CUSTOMER][NEUTRAL] Yeah,
[CUSTOMER][NEUTRAL] And the company pay amount it will yeah.
[CUSTOMER][NEUTRAL] OK, um, OK, so that sounds like it. Alright, uh, take your name and a reference number.
[AGENT][NEUTRAL] You'll use my name in today's date as your reference. [PII].
[CUSTOMER][NEUTRAL] As in [PII] in today's date. OK, thank you, [PII].
[AGENT][POSITIVE] Alrighty thank you for calling APL [PII] have a good day, OK?
[CUSTOMER][POSITIVE] You too bye thanks.