AccountId: 011433970860
ContactId: 62b024fb-043d-4d11-8a66-c6e52c13c97e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 254410 ms
Total Talk Time (AGENT): 134187 ms
Total Talk Time (CUSTOMER): 72760 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/62b024fb-043d-4d11-8a66-c6e52c13c97e_20250416T21:03_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] In [PII], this is [PII]. I'm calling with um benefit request on a patient, please.
[AGENT][POSITIVE] Alrighty, [PII], I'll be glad to help you. Go ahead and give me a good policy number, please, ma'am.
[CUSTOMER][NEUTRAL] It is 01792111.
[AGENT][POSITIVE] Alrighty, [PII], thank you for all that information. Now while I'm pulling this up, go ahead and give me a good return telephone.
[AGENT][NEUTRAL] Call number please, ma'am.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Alrighty, [PII], thank you for all of that information. Now, your patient's name and date of birth today, please, ma'am.
[CUSTOMER][NEUTRAL] It is [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Alright, [PII], thank you for all that information. Looks like [PII] is the insured on this medical supplemental plan. I do show you her original effective date is [PII] policy is current and active, but I must advise that verification of coverages, not a guarantee of payment on a claim, but you did say you want some type of benefit. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, what type of benefit are you needing today, please, ma'am?
[CUSTOMER][NEUTRAL] Um, physical therapy, uh, office setting professional.
[AGENT][NEUTRAL] Alrighty, let me get over there to that benefit. OK, let's see. OK, now of course what we are is just her medical supplemental plan. So the only thing that we would pick up and pay on is for sickness and injury that is applied towards her deductible, co-pay or co-insurance at her primary insurance carrier. Now her physical therapy outpatient benefit here is a no pre-cert, no deductible, and
[AGENT][NEUTRAL] She has a maximum of $5000 payable per calendar year.
[CUSTOMER][NEUTRAL] And what's, is there a deductible to meet first?
[AGENT][NEGATIVE] No, ma'am, no deductible, no free cert.
[CUSTOMER][NEUTRAL] And no copay, right?
[AGENT][NEUTRAL] That is correct. We are just her supplemental plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Let's see. You said it only covers sickness and injury? What if, what if they're coming in due to just like uh chronic pain?
[AGENT][POSITIVE] That is correct.
[AGENT][NEGATIVE] Well, that would have to have a medical diagnosis. We just don't pay for anything routine.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I'm sorry, I'm just not sure if the, like low back pain without an injury involved would be covered.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] As long as that's a medical diagnosis.
[AGENT][NEUTRAL] On the claim, yes, ma'am. Yeah, primarily just anything routine, you know, going in for a routine checkup, that, that kind of stuff, that would not be covered here. Anything, yeah, that has a routine diagnosis. Yes, yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, I get it.
[CUSTOMER][NEUTRAL] Um, and is there an effective date?
[AGENT][NEUTRAL] Yes, ma'am. That was [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else I can help answer for you today, [PII]?
[CUSTOMER][NEUTRAL] Uh, no. How do you spell your name?
[AGENT][NEUTRAL] My name is spelled [PII]
[CUSTOMER][NEUTRAL] Mm thanks and then is there a reference number for today?
[AGENT][NEUTRAL] No, we don't give reference numbers signed up, but you can use my name in today's date if you need to do so, OK.
[CUSTOMER][POSITIVE] All right. Thank you so much. You have a great day.
[AGENT][POSITIVE] Yes, ma'am and you as well, and thanks for calling APL, Sandra. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.