AccountId: 011433970860
ContactId: 6c7d3e7d-e68c-48a9-b82a-ffbb5839c74e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 252270 ms
Total Talk Time (AGENT): 105643 ms
Total Talk Time (CUSTOMER): 72001 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/16/6c7d3e7d-e68c-48a9-b82a-ffbb5839c74e_20250516T16:17_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I need to check benefits for outpatient physical therapy in a hospital setting, please.
[AGENT][POSITIVE] All right, [PII]. Happy to check on outpatient physical therapy benefits. Uh, what is the patient's policy number?
[CUSTOMER][NEUTRAL] So I have on the card it says policy certification number and then it says ID number. Which one do you need?
[AGENT][NEUTRAL] So it's a policy cert number it should start numerically. It doesn't have any letters in it.
[CUSTOMER][NEUTRAL] OK, it's 02580615.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And then if I could get patient's name and date of birth.
[CUSTOMER][NEUTRAL] First name is [PII] Last name [PII]. Date of birth is [PII].
[AGENT][POSITIVE] All right, thank you so much. So, patient is active. The effective date on here is [PII].
[AGENT][NEUTRAL] Uh, the plan type is a hospital indemnity plan, so it's limited benefit plan pays a set amount depending upon what the patient's being seen or treated for. So let me see.
[AGENT][NEUTRAL] But this is gonna pay towards an office visit.
[CUSTOMER][NEUTRAL] And it is um hospital outpatient facility billing.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So it looks like their outpatient benefit as far as any sort of off, you know, physician visit is gonna be a benefit amount of $75 per visit.
[AGENT][NEUTRAL] And the max for the calendar year as far as allotment is 5 visits.
[CUSTOMER][NEUTRAL] So that's for therapy or all visits they see in hospital.
[AGENT][NEUTRAL] That would be for all visits.
[CUSTOMER][NEUTRAL] OK, I don't even know how to tell what they've met and.
[AGENT][NEUTRAL] I mean, I can see if they've used any of them here. Let me see.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] Um
[AGENT][NEGATIVE] It doesn't show any sort of benefits paid to date towards any sort of office visits.
[CUSTOMER][NEUTRAL] Yeah, I mean, because we bill.
[CUSTOMER][NEUTRAL] At the end of the month I'm just afraid to tell them to come in and then they have met the 5 once they start therapy. Let me ask you this when you said $75 per visit, that's what the plan pays.
[AGENT][NEUTRAL] Right
[AGENT][NEUTRAL] Right, so that's what it pays towards the visit. It's not, because it's not a major medical, it's just a limited benefit plan. It's just gonna pay that amount.
[CUSTOMER][NEUTRAL] OK. Um,
[CUSTOMER][NEUTRAL] I think I'm gonna have the front office call them and explain this to them because they probably don't wanna go we're, we, we charge hospital billing and it's expensive, so I'm pretty sure they don't wanna come on that, um, but can I just get a reference number for this call.
[AGENT][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] Absolutely. Call references my name with my last initial and then today's date. My name again is [PII], that's [PII] and then my last initial to my name is [PII].
[CUSTOMER][POSITIVE] That's all I needed. Thank you.
[AGENT][POSITIVE] You're welcome. Have a good day.
[CUSTOMER][NEUTRAL] You too.