AccountId: 011433970860
ContactId: 7f5a1d05-6219-40bc-927e-cff604480c73
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 488589 ms
Total Talk Time (AGENT): 185662 ms
Total Talk Time (CUSTOMER): 110624 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/7f5a1d05-6219-40bc-927e-cff604480c73_20250103T20:38_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling for physical therapy benefits and eligibility.
[AGENT][NEUTRAL] OK, I can help you. And what was your name again, please, ma'am?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. OK, I can help you with the benefits. Um, what is your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Sure it's [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And then what is the patient's name?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, what's [PII]'s date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] And his policy number, please?
[CUSTOMER][NEUTRAL] It's 024.
[CUSTOMER][NEUTRAL] 46039 M for Mary, L for Lima, and the number 8 at the end.
[AGENT][POSITIVE] OK, thank you so much. Let me pull this policy in.
[AGENT][NEUTRAL] OK, this policy for [PII] lapsed on [PII].
[AGENT][NEUTRAL] Let me check though to see if he has an active policy.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You're welcome. He does. He has a different policy.
[AGENT][NEUTRAL] Uh, let me give you that policy number.
[CUSTOMER][POSITIVE] Perfect thank you.
[AGENT][NEUTRAL] You're welcome. It's 250.
[AGENT][NEUTRAL] 3116.
[AGENT][NEUTRAL] And that policy is effective [PII], so he didn't.
[AGENT][NEUTRAL] He didn't miss any coverage there, he just had a different plan. OK, let's look and you're wanting, and this is to verify benefits, it's not a guarantee of payment. This is a supplemental insurance policy that's billed secondary to the primary. It helps with deductible, co-pay, and co-insurance.
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] He has an inpatient benefit amount of $2000 per uh
[AGENT][NEUTRAL] Occurrence, and then he also has an outpatient, uh,
[AGENT][NEUTRAL] Benefit amount of $1000 per calendar day.
[AGENT][NEUTRAL] I'm going to check to see about you specifically mentioned physical therapy, so let me look at his policy.
[AGENT][POSITIVE] And see if that's covered. You're very welcome.
[CUSTOMER][POSITIVE] Yes, thank you.
[AGENT][NEUTRAL] It's gonna take a moment for the computer to pull up his policy and for me to read it and check through to see if he has physical therapy benefits.
[AGENT][NEUTRAL] I'm still looking. I haven't forgot you.
[CUSTOMER][NEUTRAL] No, it's OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Physical therapy benefits is covered on his policy.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes, OK, perfect. You said up to $1000 right? that he has $1000 for outpatient?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Let me check it again.
[AGENT][NEUTRAL] Yes, per calendar day is $1000.
[CUSTOMER][NEUTRAL] OK, and for billing purposes the correct number number that you told me was 250-3116?
[AGENT][POSITIVE] Yes, that's that's correct. You got it.
[CUSTOMER][NEUTRAL] OK, thank you, and does this policy have any termination date?
[AGENT][NEUTRAL] No ma'am, the policy is still active.
[CUSTOMER][NEUTRAL] OK, it's active.
[CUSTOMER][NEUTRAL] OK, and I'm gonna need your name. I didn't get it in the beginning.
[AGENT][NEUTRAL] Yes ma'am, it's [PII]
[CUSTOMER][POSITIVE] Thank you [PII] I'm gonna need, oh do you mind if I take another member with you?
[AGENT][NEUTRAL] No, I don't mind at all. Let me put my notes on this policy and then we'll move on to the next one.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. What is the next member's name?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] The date of birth for [PII] is [PII].
[AGENT][NEUTRAL] OK, and her policy number?
[CUSTOMER][NEUTRAL] Is 1448501.
[CUSTOMER][NEUTRAL] M for Mary, L for Lima, and the number 8 at the end.
[AGENT][NEUTRAL] OK, let me pull in her policy.
[CUSTOMER][NEUTRAL] your back
[AGENT][NEUTRAL] OK, I do show that [PII] does have an active policy and her effective date is [PII].
[AGENT][NEUTRAL] And again this is to verify benefits it's not a guarantee of payment. She has an inpatient calendar year benefit amount of $1000 and an outpatient per calendar day benefit amount of $500.
[CUSTOMER][NEUTRAL] 500.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And you said the effective day of the plan was?
[AGENT][NEUTRAL] Is [PII].
[CUSTOMER][NEUTRAL] [PII] and it's still active.
[CUSTOMER][POSITIVE] OK perfect thank you for that calendar year.
[CUSTOMER][NEUTRAL] OK [PII]
[AGENT][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] I think that we all I'm gonna need just a reference number for our for our call, OK.
[AGENT][NEUTRAL] Yes, ma'am. You can use my name, it's [PII], and today's date.
[CUSTOMER][POSITIVE] Thank you so much and have a good day.
[AGENT][POSITIVE] You too. You take care, [PII], and have a good weekend.
[AGENT][POSITIVE] Thanks for calling APL. Bye-bye.
[CUSTOMER][POSITIVE] You too bye bye thank you for your help bye.
[AGENT][POSITIVE] You're welcome.