AccountId: 011433970860
ContactId: 5e08783a-43dd-4024-b4c0-2b20b1185672
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 210600 ms
Total Talk Time (AGENT): 92922 ms
Total Talk Time (CUSTOMER): 86048 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/5e08783a-43dd-4024-b4c0-2b20b1185672_20250102T20:35_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. I'm calling from Nicholas Shilding's Hospital. I need to get benefits for a patient. This is for outpatient physical therapy.
[AGENT][NEUTRAL] OK, yes, I can check physical therapy benefits for you. Uh, what was your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK, [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. [PII].
[AGENT][NEUTRAL] OK, thank you. And then do you have uh the policy number?
[CUSTOMER][NEUTRAL] Yes, I do. It's 01611631 M as in Mary, L as in Larry 8.
[AGENT][NEUTRAL] OK thank you one moment.
[AGENT][NEUTRAL] All right. And what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] It's [PII] or [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying all of that. Uh, so the policy is active. Effective date was [PII]. You give me one moment, I'll get that policy pulled up and see if physical therapy is a covered benefit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and so I will let you know of course verification of coverage is not a guarantee of payment for claims. So physical therapy performed in a physical therapy facility is covered under their outpatient benefit. That benefit amount is $1500 max per calendar year.
[CUSTOMER][NEUTRAL] OK, and it hasn't uh been used yet.
[AGENT][NEUTRAL] Um, I don't imagine I could check though what we see. Never know.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] They just started, yeah.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Oh my goodness, I just put in 2024 day get it, that's gonna take a while to get used to.
[CUSTOMER][NEUTRAL] Yeah, me too.
[AGENT][NEUTRAL] Alright, OK, so yeah, so far this year nothing has been used.
[CUSTOMER][NEUTRAL] Let me ask you, since this will be like a coverage for as a secondary insurance, the first insurance only has like 20 visits. So, and that's per calendar year. It's a hard max. So after they use those 20 visits, um, the, this insurance APL will not cover it, right?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's correct. This plan is very dependent on major medical. If major medical does not cover anything, this policy cannot.
[CUSTOMER][NEUTRAL] OK, so it will be like uh um uh up to $1500 for the copay, the doctor or anything that has to do with the primary.
[AGENT][NEUTRAL] Co-pay, deductible and co-insurance, yes.
[CUSTOMER][NEUTRAL] OK. OK. Do you have a reference number for the call?
[AGENT][NEUTRAL] Yeah, reference number would just be my first name, last initial, and today's date and so my name is spelled [PII] last initial [PII], was there anything else I could help you with, [PII]?
[CUSTOMER][POSITIVE] No, no, that's it. Thank you so much. Have a good day.
[AGENT][POSITIVE] All right, yeah, thanks for calling APL. You too. Bye bye.
[CUSTOMER][NEUTRAL] OK. Bye-bye.