AccountId: 011433970860
ContactId: 99c3e142-958a-464f-9714-e6bea1a85336
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 278619 ms
Total Talk Time (AGENT): 132186 ms
Total Talk Time (CUSTOMER): 83137 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/99c3e142-958a-464f-9714-e6bea1a85336_20250114T15:38_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hello, my name is [PII]. Uh, last initial is [PII]. I'm calling from Physical therapy now to check uh benefits for a member, please.
[AGENT][POSITIVE] OK, yeah, I'd love to help you with some benefits today, [PII]. Do you mind if I snag a good callback number from you real quick?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number?
[CUSTOMER][NEUTRAL] Uh, it is 1, I'm sorry, 01611631 M as in Mary, L as in Lima, and number 8.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Wonderful. And if you don't mind giving me just a minute to get that policy pulled up.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And would you be able to verify for me pretty please that uh the patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][POSITIVE] Perfect, thank you so much. I do see [PII] here, he is current and active with an effective date of [PII] and.
[AGENT][NEUTRAL] Are you looking for inpatient or outpatient benefits today?
[CUSTOMER][NEUTRAL] Outpatient.
[AGENT][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] I'm calling because uh he has a primary insurance.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] With a neighborhood plan with Healthcare, and he has a co-payment and you wanna know basically if if you guys cover the co-payment.
[AGENT][NEUTRAL] Oh, OK, yeah, so our plan is designed to pick up and pay on co-payment, co-insurance and deductibles that are um left behind for major medical, um.
[AGENT][NEUTRAL] For accident, injury or sickness, uh, we don't cover anything routine.
[AGENT][NEUTRAL] Uh, your patient does have an outpatient calendar year benefit of $1500 per calendar year.
[CUSTOMER][NEUTRAL] OK, so he has available 1500 per year.
[AGENT][NEUTRAL] Yes, that, that can be a uh, that can be benefited on charges applied to co-pay coinsurance or deductible.
[CUSTOMER][NEUTRAL] OK. And for physical therapy applied?
[AGENT][NEUTRAL] Um, yeah, let me take a look at his policy documents. Um, typically it does count for physical therapy, but I will pull up those documents for you, and I can't remember if I said this, so I'm really sorry if I'm saying it twice, um, but.
[AGENT][NEUTRAL] Any benefit information I give you over the phone it's just a verification of coverage and never a guarantee of payment.
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] Hang tight. I'm just scrolling to that part of the benefits.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, it does say um it covers him in a physical therapy facility.
[CUSTOMER][NEUTRAL] It covers, OK.
[AGENT][NEUTRAL] Yeah, it has a list um it has it listed in uh his.
[CUSTOMER][POSITIVE] Great.
[AGENT][NEUTRAL] In this coverage.
[CUSTOMER][NEUTRAL] OK. Of the $1500 is something has been used this year?
[AGENT][NEUTRAL] Yeah, let me take a look if we've used any of that yet this year.
[AGENT][NEUTRAL] It doesn't look like we've had anything on file yet for [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, great.
[CUSTOMER][NEUTRAL] But this 1500 is in general for me it's not only for physical therapy, correct?
[AGENT][NEUTRAL] Um, yeah, that is, that's his total outpatient calendar year, um, benefit.
[CUSTOMER][POSITIVE] OK, OK, got it. OK, very cool. That's all that I need to know.
[AGENT][POSITIVE] Perfect. I'm glad I was able to help you out today. Is there anything else you need, [PII]?
[CUSTOMER][POSITIVE] Thank you. And uh can
[CUSTOMER][NEUTRAL] Yes, can
[CUSTOMER][NEUTRAL] Yes, your name and uh reference number for the call please.
[AGENT][NEUTRAL] You betcha. So my name is [PII], first initial last name, [PII], and the reference number is just my name, my last initial and today's date.
[CUSTOMER][POSITIVE] OK. Thank you, [PII]. Have a wonderful day. Bye-bye.
[AGENT][POSITIVE] My pleasure, [PII] you too and thanks for calling APL you take care.