AccountId: 011433970860
ContactId: 8f0e3058-bbd9-4b73-8761-c4a6bb8d284b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 196660 ms
Total Talk Time (AGENT): 95970 ms
Total Talk Time (CUSTOMER): 60285 ms
Interruptions: 0
Overall Sentiment: AGENT=2, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/8f0e3058-bbd9-4b73-8761-c4a6bb8d284b_20250213T21:34_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my group number is 25026.
[AGENT][NEUTRAL] OK, may I have your name and are you calling on behalf of the group or you're an insured?
[CUSTOMER][NEUTRAL] I'm an insured and my name is [PII].
[AGENT][NEUTRAL] And [PII], um, can you repeat the group number I typed over it by mistake, I'm sorry.
[CUSTOMER][NEUTRAL] 25026
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And [PII], can you verify your date of birth, your mailing and email address on file?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[CUSTOMER][NEUTRAL] It's [PII]. And uh and what else did you want?
[AGENT][NEUTRAL] Your mailing address?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And how may I assist you today?
[CUSTOMER][NEUTRAL] I needed to find out if I go to an outpatient center for therapy on my back.
[CUSTOMER][NEUTRAL] Is that covered under the gap?
[AGENT][NEUTRAL] Therapy on your back, like what type of therapy? Like is it a chiropractor or?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] It's not a chiropractor, it's therapy, you know, it's like um
[CUSTOMER][NEUTRAL] Oh, what, how would I say that therapy, you know, it.
[AGENT][NEUTRAL] Like physical therapy?
[CUSTOMER][NEUTRAL] Physical therapy, correct.
[AGENT][NEUTRAL] OK, um, hold on one moment. Let me take a look at your coverage.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm just waiting for your benefits to pop up here. Hold on one moment.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] OK, so your um policy does pay up to $500 per day um for outpatient expenses, which does include physical therapy in a physical therapy facility.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so we apply after primary, so as long as primary, um, applies towards the claim, we can. If primary does not, we cannot.
[CUSTOMER][NEUTRAL] OK, how about if primary has a deductible?
[AGENT][NEUTRAL] So, our policy pays towards the copay, deductible and co-insurance. However, if the provider is saying that you have to pay that to be seen, then you would have to pay that upfront and then on the back end, when we receive the claim, you could be reimbursed up to that $500 per calendar day.
[CUSTOMER][NEUTRAL] OK, do you have like a maximum of times that I can go or no?
[AGENT][NEUTRAL] No, your policy, so basically you have $500 to use every day. It resets each day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect. OK, thank you so much for your help.
[AGENT][POSITIVE] You're very welcome. Was there anything else I could assist you with today?
[CUSTOMER][POSITIVE] No, that's it. Thank you so much.
[AGENT][POSITIVE] You're welcome. Well, thanks for calling [PII]. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you bye bye.
[CUSTOMER][NEUTRAL] Bye bye.