AccountId: 011433970860
ContactId: 9933563c-bcee-4d61-af4a-21e58b911815
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 176360 ms
Total Talk Time (AGENT): 95252 ms
Total Talk Time (CUSTOMER): 57459 ms
Interruptions: 1
Overall Sentiment: AGENT=1.3, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/9933563c-bcee-4d61-af4a-21e58b911815_20250122T20:13_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] and I'm calling from Hillcrest um Hospital South provider's office. I'm just trying to verify physical therapy benefits for a patient.
[AGENT][NEUTRAL] OK, yeah, I can look at those physical therapy benefits. Um, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, [PII], that's a direct line.
[AGENT][NEUTRAL] All right, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I do. It is 02462880.
[AGENT][NEUTRAL] OK, thank you. And what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, the name is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that [PII]. Uh, so this policy is active. Effective date was [PII], and this is a secondary medical policy, so it is designed to help with co-pay, deductible and co-insurance after major medical pays. Bear with me just a moment, let me check.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm gonna get the policy pulled up here and look at those see if physical therapy is offered.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] All right. Of course, I will let you know verification of coverage is not a guarantee of payment for claims. So under their outpatient benefit, uh, it does state uh physical therapy when performed in a physical therapy facility. So it is going to be covered. Um, the outpatient benefits, let me get that for you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is $7500 max per calendar year if you'll give me one moment I'll, I know the year just started, but we'll see if that's any of that's been used.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, and none of that has been used so far this year?
[CUSTOMER][NEUTRAL] And that's basically the um you guys will pay out up to that amount, is that what you meant by that? OK OK and do you guys have any restrictions on visit limits or any kind of authorization requirements?
[AGENT][POSITIVE] Correct, yes, yes.
[AGENT][NEUTRAL] No, again, it's very dependent on major medical as long as her primary is willing to pay, then this plan can.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] I got you I got you. Sounds good makes sense. OK, may I get a call reference number please?
[AGENT][NEUTRAL] Yeah, reference number would just be my first name, last initial and today's date. Uh so my name is spelled [PII] And was there anything else I could help you with, [PII]?
[CUSTOMER][POSITIVE] That is it. I appreciate your help. Thank you so much.
[AGENT][POSITIVE] Alright, yeah, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][POSITIVE] Thank you. Bye bye.
[CUSTOMER][NEUTRAL] Bye bye