AccountId: 011433970860
ContactId: 86ca1c6f-e82d-4330-95e8-3d83ea43961b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 311660 ms
Total Talk Time (AGENT): 103640 ms
Total Talk Time (CUSTOMER): 61607 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/13/86ca1c6f-e82d-4330-95e8-3d83ea43961b_20250613T17:27_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 am calling from a provider's office trying to verify benefits and eligibility for a mutual patient.
[AGENT][NEUTRAL] I can help you with benefits and eligibility. Uh, [PII], can I get a good call back number in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the policy number?
[CUSTOMER][NEUTRAL] Policy number is hiding. Hold on one second.
[CUSTOMER][NEGATIVE] The computer would freeze.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] 02475819.
[AGENT][NEUTRAL] OK give me just a moment to look that up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth for me please?
[CUSTOMER][NEUTRAL] [PII], um [PII].
[AGENT][POSITIVE] Great, thank you so much.
[AGENT][NEUTRAL] OK, it looks like this policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And uh were there specific benefits that you had questions on inpatient or outpatient?
[CUSTOMER][NEUTRAL] Uh, it's gonna be outpatient and let me see.
[CUSTOMER][NEUTRAL] To be outpatient physical therapy.
[AGENT][NEUTRAL] OK, give me just a moment.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Oh, go ahead.
[CUSTOMER][NEUTRAL] Is it a um a calendar year plan?
[AGENT][NEUTRAL] Um, let me look.
[AGENT][NEUTRAL] OK, yes, it is a calendar, a calendar year plan.
[AGENT][NEUTRAL] And uh this is just a verification of benefits, not a guarantee of payment. It looks like they have an outpatient benefit maximum of up to $4000 per calendar year.
[AGENT][NEUTRAL] Uh, with a $0 outpatient deductible per calendar year. And let's see, um, physical therapy.
[AGENT][NEUTRAL] As long as it's in a physical therapy facility, it's a uh they get up to 30 days of treatment per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Does it share frequency with anything?
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Let me look.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It looks like it just goes towards the the outpatient benefit maximum it doesn't share frequency.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All righty.
[CUSTOMER][NEUTRAL] Sorry, I'm I'm trying to make sure I ask all the questions before we end our call.
[AGENT][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] Uh, does the patient have a co-pay or a co-insurance?
[AGENT][NEUTRAL] Um, so this is actually their secondary gap insurance. So this insurance helps cover the cost of co-pay, co-deductible, and co-insurance. Uh, they have a $0 outpatient deductible per calendar year for this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I just wanted to make sure.
[CUSTOMER][NEUTRAL] And can I get a reference number to this phone call, please?
[AGENT][NEUTRAL] So we don't have call reference numbers, but you can use my name and last initial in today's date, so [PII] in today's date.
[CUSTOMER][POSITIVE] Awesome thank you so much, [PII]. I appreciate your time with me today.
[AGENT][POSITIVE] Great, thank you for calling APL. I hope you have a great weekend.
[CUSTOMER][POSITIVE] You too. Thank you.
[AGENT][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Alright bye bye.