AccountId: 011433970860
ContactId: 9758f731-eddc-45e0-88ca-ee0e4029d67c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 197979 ms
Total Talk Time (AGENT): 107127 ms
Total Talk Time (CUSTOMER): 63230 ms
Interruptions: 1
Overall Sentiment: AGENT=1.8, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/9758f731-eddc-45e0-88ca-ee0e4029d67c_20250130T14:44_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I'm looking to verify eligibility and benefits for physical therapy.
[AGENT][POSITIVE] OK, well I can definitely assist you with the eligibility and physical therapy benefits. And may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Mhm it's [PII] and the phone number is [PII].
[AGENT][NEUTRAL] Thank you for that. And [PII], may I have a good um a policy number for the patient, I'm sorry.
[CUSTOMER][NEUTRAL] That would be the payer ID right on the card?
[AGENT][NEUTRAL] No, the payer ID is for electronic payments. It'll say in hospitals or outpatient policy er number.
[CUSTOMER][NEUTRAL] OK, let me see the, OK, so I'll do the outpatient.
[AGENT][NEUTRAL] Mhm. The numbers are the same. The ML 7 or 8 at the end is different.
[CUSTOMER][NEUTRAL] OK, so it's 024152.
[CUSTOMER][NEUTRAL] 65.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[AGENT][NEUTRAL] And all the information provided is a verification of benefits, not a guarantee of payment. I am showing that the policy is active. It's been effective since [PII].
[CUSTOMER][NEUTRAL] It don't know.
[AGENT][NEUTRAL] And hold on one moment, I'm waiting for the benefits to pop up here so I can see for physical therapy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And under outpatient, the policy will pay up to $400 per calendar day. That does include physical therapy and a physical therapy facility, but if it is included or considered an office, um, she also has the or he also has the office treatment rider, um, to where any treatment in the office could be covered up to that $400 per day as long as it's not cosmetic.
[CUSTOMER][NEUTRAL] OK, so it's fully covered for therapy then.
[AGENT][NEUTRAL] I mean, depending on your pricing and how you're coding, yes, either if it's in the facility or office, there's coverage up to $400.
[CUSTOMER][NEUTRAL] OK, and is there a deductible or out of pocket?
[AGENT][NEUTRAL] No, not for the secondary, but if primary applies, that we help pay that.
[CUSTOMER][NEUTRAL] OK, uh, does he have a visit limit under?
[CUSTOMER][NEUTRAL] This policy
[AGENT][NEUTRAL] Um, not for physical therapy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And can I get a reference number for this call?
[AGENT][NEUTRAL] Sure, um, so there's no call reference number, but you can use my name in today's date. So again, my name is [PII], first initial to my last name is [PII], and then today's date.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK thank you so.
[AGENT][POSITIVE] You're very welcome, [PII]. Was there anything else I can help you with?
[CUSTOMER][NEUTRAL] That was it.
[AGENT][POSITIVE] Alright, thanks for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] Bye bye.