AccountId: 011433970860
ContactId: 9ace5730-572e-4bc2-92e0-79ad767885d8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 265040 ms
Total Talk Time (AGENT): 136103 ms
Total Talk Time (CUSTOMER): 83944 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/9ace5730-572e-4bc2-92e0-79ad767885d8_20250425T17:26_UTC.wav
--------------------------------------------
[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 need to get benefits for a patient.
[AGENT][NEUTRAL] OK [PII], do you also need eligibility or strictly just benefit information?
[CUSTOMER][POSITIVE] Just benefits.
[AGENT][POSITIVE] OK, yes, ma'am. I can help you with that. And [PII], what is the callback number for you, please?
[CUSTOMER][NEUTRAL] [PII] direct line.
[AGENT][POSITIVE] Thank you. And the member's policy number.
[CUSTOMER][NEUTRAL] It is D43600381.
[AGENT][NEUTRAL] OK, thank you, but [PII], that is not an APO policy number. That is a 90 degree or IMA benefit number.
[CUSTOMER][NEUTRAL] OK, let me get the card here and see what it says here.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I have a medical ID or a policy cert number.
[AGENT][NEUTRAL] I need the policy number.
[CUSTOMER][NEUTRAL] OK, it's 02300654.
[AGENT][NEUTRAL] OK, thank you, one moment.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] And any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. [PII], what is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, it is [PII], [PII].
[AGENT][POSITIVE] OK, thank you. So how can I help you today on this limited benefit plan?
[CUSTOMER][NEUTRAL] Um, I need to see if she has any benefits for outpatient physical therapy.
[AGENT][NEUTRAL] OK, so for physical, speech, excuse me. Physical, speech, or yes, and that's a lot for me to try to spit out real quick like that. I, oh, OK. So related to outpatient accident or sickness treatment for physical, speech, or occupational therapy.
[CUSTOMER][NEUTRAL] It's Friday.
[AGENT][NEUTRAL] Facility, the benefit is $30 per day, a maximum of 4 days per calendar year per covered person.
[CUSTOMER][NEUTRAL] OK, and have they used any of those 4 days?
[AGENT][NEUTRAL] I can check that.
[CUSTOMER][NEUTRAL] So.
[AGENT][NEGATIVE] As of now, no, ma'am. They, there have not been any benefits used.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and do they have an out of pocket max?
[AGENT][NEUTRAL] This is not major medical insurance. This is a hospital indemnity limited benefit plan. So the $30 per day is the benefit and a maximum of 4 days per calendar year per person.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and I'm assuming no authorization is required then, correct?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Excuse me, and what about a doctor's order? Is that required?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, and [PII], is it [PII]?
[AGENT][POSITIVE] No, [PII], but thank you for asking.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, and what's your last initial?
[AGENT][NEUTRAL] [PII], and you would use my name along with today's date as your call reference number and then [PII], if you all do end up filing a claim with us for this number, once it's been processed, uh, we do have a portal that you should be able to check claim status in, and the website for the portal is located at [PII].
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, and I have one more question for you. Does this run on a calendar year or a service year?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This is a calendar year for the benefits.
[CUSTOMER][NEUTRAL] Calendar year OK.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] OK, thank you very much, [PII].
[AGENT][POSITIVE] Well, you are certainly very welcome. Is there anything else I can help you with today, [PII]?
[CUSTOMER][NEUTRAL] Nope, that was it.
[AGENT][POSITIVE] OK, well, thank you so much then for calling APL and I hope you have a great weekend.
[CUSTOMER][NEUTRAL] You too, bye.
[AGENT][POSITIVE] Yes, ma'am. Thank you. Bye bye.