AccountId: 011433970860
ContactId: 889068c2-f505-41da-abfc-0b89860ded42
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 402660 ms
Total Talk Time (AGENT): 171715 ms
Total Talk Time (CUSTOMER): 131035 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/889068c2-f505-41da-abfc-0b89860ded42_20250421T20:22_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling from Day Physical Therapy trying to figure out if this um secondary APL covers physical therapy for the patient.
[AGENT][NEUTRAL] OK, and you said your name is [PII], correct?
[CUSTOMER][NEUTRAL] [PII], yes.
[AGENT][NEUTRAL] Oh, [PII]. OK, I'm sorry. And you're wanting to find out about physical therapy benefits, is that correct?
[CUSTOMER][NEUTRAL] The physical therapy and a specialist office, yes.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number please, [PII]?
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] 02353542 MLB
[AGENT][NEUTRAL] 8.
[AGENT][NEUTRAL] It should be an 8.
[CUSTOMER][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] The last, it's, it's an 8.
[CUSTOMER][NEUTRAL] Oh, is that an 8 ML 8?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, and any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name please, [PII], and their date of birth?
[CUSTOMER][NEUTRAL] 7
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[AGENT][NEUTRAL] OK, so maybe I misheard the number. Um, I heard 02353542.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] What's the first part of the number? OK, that is, that's incorrect. That pulls up a completely different number.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] All right, so
[CUSTOMER][NEUTRAL] Let me bring that up over here and let me verify his number.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Give me a moment.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] If my system would come up.
[AGENT][POSITIVE] It's no worries.
[CUSTOMER][NEUTRAL] Oh my lord, I'm working off a laptop today, so it's like.
[CUSTOMER][POSITIVE] Can't get any slower.
[AGENT][POSITIVE] Oh goodness.
[CUSTOMER][POSITIVE] Your goodness is correct, so let me see here.
[CUSTOMER][NEUTRAL] So why is this man's things up here? Here we go.
[CUSTOMER][NEGATIVE] It's obviously not on the image that I want.
[CUSTOMER][NEUTRAL] OK, so let's try this. It is hold on outpatient 0235.
[CUSTOMER][NEUTRAL] 9. OK, here we go, 954.
[CUSTOMER][NEUTRAL] 9542 ML 8.
[AGENT][NEUTRAL] OK, thank you. So one moment.
[AGENT][NEUTRAL] OK, and if you would please verify the patient's date of birth again for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So that is the correct policy number that you just gave me for him. OK.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Hi
[CUSTOMER][NEUTRAL] from physical therapy, how are you?
[CUSTOMER][NEUTRAL] Good, can you come in at [PII]? We just got a cancellation for tomorrow.
[AGENT][NEUTRAL] OK, so I do show that.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] He is the subscriber on the supplemental policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, ma'am, [PII], he is a subscriber on the supplemental policy. It is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And he does have an office treatment writer on this policy, so the outpatient benefit maximum per calendar year for covered outpatient services is $1500 and there is no deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So it covers up to $1500.
[AGENT][NEUTRAL] For covered outpatient services.
[CUSTOMER][NEUTRAL] OK, right.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Now, because it is a supplement.
[CUSTOMER][NEUTRAL] And does he have anything left in there?
[AGENT][NEUTRAL] I can check.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Because this is while this other information is pulling up because this is a supplemental policy to his primary insurance when the claim is submitted to APL for review, we will also have to have a copy of his primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No
[CUSTOMER][POSITIVE] OK perfect
[AGENT][NEUTRAL] As well
[AGENT][NEUTRAL] And as about and as of now, any of his benefits for this calendar year.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And then once we have received and processed the claim here at APL, [PII], we do have a portal in which you should be able to check claim status and our website for the portal is located at [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK thanks.
[AGENT][POSITIVE] Yes, ma'am. You're welcome. So is there anything else, [PII] I could help you with?
[CUSTOMER][NEUTRAL] I've gotten
[CUSTOMER][NEUTRAL] Um, just a, oh, you were gonna tell me he has um funds in there.
[AGENT][NEUTRAL] As of now, he has not, as of now, he has not used any of his benefits for this calendar year.
[CUSTOMER][NEUTRAL] Available?
[CUSTOMER][NEUTRAL] 3
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Wonderful. OK, can I have a reference number and we are good?
[AGENT][NEUTRAL] Yes, ma'am, you would use my name that I gave you along with today's date.
[CUSTOMER][POSITIVE] OK, thank you so much, [PII] have a good day.
[AGENT][POSITIVE] Oh, you're, yes, ma'am. You too, [PII], and thank you again for calling APL if that's all then that I could help you with.
[CUSTOMER][POSITIVE] OK thank you bye bye.
[AGENT][POSITIVE] You're welcome. Bye bye.