AccountId: 011433970860
ContactId: 5ec78fb6-341a-4b80-9d6b-39e72d3f42a9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 304940 ms
Total Talk Time (AGENT): 129742 ms
Total Talk Time (CUSTOMER): 82418 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/27/5ec78fb6-341a-4b80-9d6b-39e72d3f42a9_20250327T18:09_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from orthopedic rehabilitation specialist. I'm calling to, um, because the patient has American Public Life as their secondary insurance, and I'm trying to see if there's any benefits, uh, when it comes to physical therapy done in the office setting.
[AGENT][NEUTRAL] OK, Miss [PII], I can check the benefits for you. Can I please get your callback number just in case the call gets disconnected?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yes, my callback number is [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Uh, the patient's name is [PII], and the date of birth is [PII].
[CUSTOMER][NEUTRAL] Uh, the policy number is 0203.
[CUSTOMER][NEUTRAL] 018.
[CUSTOMER][NEUTRAL] 6 M as in Mary, L as in Lima 8.
[AGENT][NEUTRAL] OK, let me pull up that policy for us real quick.
[CUSTOMER][NEUTRAL] There
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, I do show that [PII] does have an active policy and her effective date is [PII].
[AGENT][NEUTRAL] And let's look and see as far as um benefits.
[AGENT][NEUTRAL] And this is just to verify your benefits it's not a guarantee of payment.
[AGENT][NEUTRAL] I'm going to need to pull up the policy itself to see if there's any physical therapy benefits so I can read it.
[CUSTOMER][NEUTRAL] Um-hum.
[AGENT][NEUTRAL] It's gonna be just a second while I pull that in.
[CUSTOMER][NEUTRAL] Oh and
[CUSTOMER][NEUTRAL] Um, hold on, I'm sorry.
[AGENT][NEUTRAL] OK, so, um.
[AGENT][NEUTRAL] On this policy for outpatient, she does have physical therapy benefits if uh is in a covered physical therapy facility.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, is it just not covered if it's in an office setting, or?
[AGENT][NEUTRAL] Let me see if she has office visits.
[AGENT][NEUTRAL] OK, so office visits for this policy are not covered, but a physical therapy is.
[CUSTOMER][NEUTRAL] OK, because we bill physical therapy but in an office setting so it wouldn't be covered?
[AGENT][NEUTRAL] Well, the office visit fee for the physician would not be covered, but the treatment would.
[AGENT][NEUTRAL] So this is what it says for um physical therapy facility.
[AGENT][NEUTRAL] Is an office oh it does say office an office center or clinic in which a licensed physical therapist provides physical therapy, so yes, it would be covered.
[CUSTOMER][NEUTRAL] OK, um, what exactly does it cover or how much does it cover?
[AGENT][NEUTRAL] Uh, let me give you her benefits for outpatient, and this policy helps with deductible, co-pay, and co-insurance.
[AGENT][NEUTRAL] And they have $2500 per calendar year.
[CUSTOMER][NEUTRAL] OK, cover.
[CUSTOMER][NEUTRAL] Co-pay
[CUSTOMER][NEUTRAL] You said 2500?
[AGENT][NEUTRAL] Yes ma'am, and I looked up and nothing has been used for the year of [PII] for the outpatient benefit.
[CUSTOMER][POSITIVE] OK perfect all right thank you so much um that was everything I needed uh could I just get a reference number please? Sorry.
[AGENT][POSITIVE] You're very welcome.
[AGENT][NEUTRAL] OK, [PII].
[AGENT][POSITIVE] Yes ma'am, you can use my name and today's date. I'm sorry miss [PII], I called you [PII]. I apologize.
[CUSTOMER][POSITIVE] No, it's no problem.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right thank you so much for all your help.
[AGENT][POSITIVE] You're very welcome. I hope you have a great day and thank you for calling APL.
[CUSTOMER][POSITIVE] Alright thank you have a great day.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.