AccountId: 011433970860
ContactId: 795e18e6-eb7e-44cd-a609-62366ee9acf9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 262600 ms
Total Talk Time (AGENT): 112506 ms
Total Talk Time (CUSTOMER): 123107 ms
Interruptions: 5
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/795e18e6-eb7e-44cd-a609-62366ee9acf9_20250129T16:38_UTC.wav
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[CUSTOMER][NEUTRAL] I understand.
[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I'm calling from the provider's office to get benefits for the supplemental plan on a patient.
[AGENT][POSITIVE] OK, yeah, I can check benefits for you. What was your name?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] What was your name? I'm sorry?
[AGENT][NEUTRAL] It's [PII]
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Uh huh. And then, uh, can I, can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, thank you. Do you have the policy number?
[CUSTOMER][NEUTRAL] I have the.
[CUSTOMER][NEUTRAL] Outpatient benefit certification number. Can I give you that? OK, it's gonna be 02419107 M as in Mary, L as in Larry 8.
[AGENT][NEUTRAL] Mhm. Yes.
[AGENT][NEUTRAL] OK, thank you and what was the name and date of birth for the member?
[CUSTOMER][NEUTRAL] Name of the member is [PII] and then the date of birth, give me one second. I no different.
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that Camilla. Uh, so this policy is active. Effective date was [PII], and this is a secondary medical policy, so it is designed to help with co-pay, deductible and co-insurance after major medical pays, and we need to look at the outpatient benefits?
[CUSTOMER][NEUTRAL] Outpatient, yes.
[AGENT][NEUTRAL] OK, of course I will let you know verification of coverage is not a guarantee of payment for claims. The outpatient benefit is $2000 max per calendar year. If you'll give me one moment, I'll see if any of that has been used.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, none has been used so far this year.
[CUSTOMER][NEUTRAL] OK, does the plan cover office visits?
[AGENT][NEUTRAL] Oh, let me check that. Give me just a moment.
[CUSTOMER][NEUTRAL] Because I put
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, so office visits are not covered under this policy, however, treatment received in office could be.
[CUSTOMER][NEUTRAL] So like X-rays and ultrasounds could be?
[AGENT][NEUTRAL] Correct, if it's just simply like a consultation or just simply the visit then that would not be covered um but yes, treatment received in office could be.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, and then can I check if physical therapy, co-pay in an office would be covered?
[AGENT][NEUTRAL] Um, let me check this policy. Just give me just a moment.
[AGENT][NEUTRAL] Typically, with these, if physical therapy is covered, it would have to be in a physical therapy facility. Uh, but let me double check. Give me just a moment.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] That's this one from our.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] When I go to my primary care doctor they give me.
[CUSTOMER][NEUTRAL] They give you a receipt.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The office.
[AGENT][NEUTRAL] OK, yes. So physical therapy is covered at a physical therapy facility under this policy.
[CUSTOMER][NEUTRAL] yeah yeah my friend.
[CUSTOMER][NEUTRAL] Uh, what about, because what they do is they they build and call um the billing um. OK, can I have a reference number for the call please? And then like you said you know um.
[AGENT][NEUTRAL] Sure, reference number would just be my first name, last initial, and today's date. Uh, so my last initial is [PII], was there anything else I can help you with [PII]?
[CUSTOMER][NEUTRAL] OK, sorry, yes, one more question for durable medical equipment, would you guys cover?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] That that is covered under this policy. They do have a DME benefit.
[CUSTOMER][NEUTRAL] With you guys, how can I.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] Of course, yeah, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too bye.