AccountId: 011433970860
ContactId: 91775e0f-6bf6-4e1c-9152-c7267ed20464
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 283339 ms
Total Talk Time (AGENT): 116324 ms
Total Talk Time (CUSTOMER): 89281 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/91775e0f-6bf6-4e1c-9152-c7267ed20464_20250401T14:15_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi good morning I was on the phone with Multiplan trying to get eligibility and benefits for a mutual patient, um, but they told me to contact you guys, um, because I guess that's who's the carrier for this patient, so I just wanted to see if like we're in network and stuff like that.
[AGENT][NEUTRAL] OK. OK.
[AGENT][POSITIVE] Yeah, I'm happy to check benefits. What's the policy number?
[CUSTOMER][NEUTRAL] Um, that's different from the medical ID, correct?
[AGENT][NEUTRAL] What does the medical ID start with?
[CUSTOMER][NEUTRAL] D as in dog.
[AGENT][NEUTRAL] Yeah, it's different than that.
[AGENT][NEUTRAL] Usually it's
[CUSTOMER][NEUTRAL] OK, so the policy number.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 02592661.
[AGENT][NEUTRAL] All right, thank you for that. And then if I can grab your first name and a callback number, please?
[AGENT][NEUTRAL] And patient's name and date of birth please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] I have [PII].
[AGENT][NEUTRAL] Thank you. So the patient is active. The effective date is [PII].
[AGENT][NEUTRAL] This is a a limited benefit plan so it's just gonna pay a set amount depending upon what the patient's being seen for they're coming in for like an office visit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, yeah, she said that she um injured her right shoulder and the uh doctor is sending her out to us for physical therapy.
[AGENT][NEUTRAL] Physical therapy, OK. Let me take a look.
[AGENT][NEUTRAL] So on the patient plan, it looks like they're allowed under their outpatient, a maximum of 5 visits in a calendar year.
[AGENT][NEUTRAL] And the benefit payment towards each visit is $75.
[CUSTOMER][NEUTRAL] Like the copay?
[AGENT][NEUTRAL] No, it's not a co-pay. So this plan will pay $75 towards the office visit, whatever that fee is that the doctor charges.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Plan pays.
[AGENT][NEUTRAL] And I don't show that they've used any of their office visits for the year.
[CUSTOMER][NEUTRAL] And you said it was 5 visits for the calendar year?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, do you know if there's any deductible or anything like that towards it, or it's just strictly they just paid $75 towards the plan with 5 visits?
[AGENT][NEUTRAL] Yep, just 75 towards the visit, um, with 5 visits, no deductible, co-insurance, anything like that.
[CUSTOMER][NEUTRAL] OK, um, how do we go about if we need to request for more visits?
[AGENT][NEUTRAL] Um.
[AGENT][POSITIVE] You can definitely send something to, I can give you a mailing address.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Are you ready?
[CUSTOMER][NEUTRAL] Yes I am.
[AGENT][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] I'm sorry, [PII].
[AGENT][NEUTRAL] Mhm. Yes, ma'am.
[CUSTOMER][NEUTRAL] Mhm OK mhm.
[AGENT][NEUTRAL] And that's in [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so we would just basically uh send out like a progress note to that [PII] box you gave me.
[AGENT][NEUTRAL] You could, yes, absolutely. The insured, this is a limited benefit plan, so it's not a major medical. Um I don't know if they have any other insurance, but that's why it just pays that set amount and has those limited visits.
[CUSTOMER][NEUTRAL] Got you. OK, um, I'll go over it with my boss um I'll see him in the morning and then, um, we'll go from there and I'll let the patient know. Thank you. What's your name?
[AGENT][NEUTRAL] You're welcome. My name is [PII].
[CUSTOMER][POSITIVE] Thank you [PII] have a good day.
[AGENT][POSITIVE] You're welcome you too bye bye.