AccountId: 011433970860
ContactId: 6324704f-05c0-419d-9fe2-1b39128e68ce
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 250470 ms
Total Talk Time (AGENT): 110068 ms
Total Talk Time (CUSTOMER): 86558 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/18/6324704f-05c0-419d-9fe2-1b39128e68ce_20250618T18:52_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, yes, I'm calling to see if you can let me know if we are in network with this one, with this insurance, and if we are if we can get benefits on the patient.
[AGENT][NEUTRAL] OK, yeah, I can take those benefits and then of course uh the network for that policy um what was your name? I'm sorry.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh yes, it's [PII].
[AGENT][NEUTRAL] OK, thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] Um, yes, it is, they gave me like a certification number, but this is a 01719341 M as in Mary 18.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] It is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Perfect. OK, thank you so much for verifying that. Uh, so this policy is active. Um, [PII]'s effective date on the policy was his birthday, [PII]. Um, so this is a secondary medical policy. It is designed to help with co-pay, deductible and co-insurance after major medical pays, and this policy is very dependent on major medical, so as long as they're willing to pay this policy can.
[AGENT][NEUTRAL] So there's no network or anything. It simply follows uh their major medical.
[CUSTOMER][NEUTRAL] OK, so anything like cause then they are gonna have a therapy.
[CUSTOMER][NEUTRAL] Is that one also be considered like a major medical?
[AGENT][NEUTRAL] Is this uh physical therapy?
[CUSTOMER][NEUTRAL] It is, I believe it was for physical. Give me a moment.
[CUSTOMER][NEUTRAL] Uh, it's for occupational therapy.
[AGENT][NEUTRAL] OK, I can go ahead and check that um what I meant by um major medical was their primary, whoever they have as their primary insurance. um, it follows them regarding network and stuff, yeah, but of course this does have its own policy, so give me just a moment, let me see if that is a covered benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so occupational therapy is not going to be a covered benefit under this policy.
[CUSTOMER][NEUTRAL] OK, so, OK, so this one, the secondary of this one won't cover it then.
[AGENT][NEGATIVE] Not for occupational therapy, no.
[CUSTOMER][NEUTRAL] OK. OK. Would it cover with any other therapies if they were to come in for anything else?
[AGENT][NEUTRAL] I do believe physical therapy is covered. Let me verify that.
[CUSTOMER][NEUTRAL] Like for speech or if it's.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, yeah, um, physical therapy performed in the physical therapy facility is going to be covered under their outpatient benefits, but, um, no speech, occupational, uh, nothing like that would be covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, OK, then, then that'll be it then. Do you also have a call reference number?
[AGENT][NEUTRAL] Sure, it would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII] Was there anything else I could help you with?
[CUSTOMER][POSITIVE] OK, no that'll be it and thank you so much for your help.
[AGENT][POSITIVE] Alright, of course, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][POSITIVE] Thank you. Bye bye.