AccountId: 011433970860
ContactId: 9c15839b-0d60-4fc6-97a6-6387829bb394
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 215949 ms
Total Talk Time (AGENT): 103578 ms
Total Talk Time (CUSTOMER): 137949 ms
Interruptions: 12
Overall Sentiment: AGENT=1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/11/9c15839b-0d60-4fc6-97a6-6387829bb394_20250311T19:55_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good afternoon, [PII]. My name is [PII] and I'm calling from Shan's Teaching Hospital, and I just need to verify benefits for physical therapy, please.
[AGENT][NEUTRAL] OK, [PII], you're needing physical therapy benefits, is that correct?
[CUSTOMER][NEUTRAL] Hey, yes, so you're needing physical therapy benefits, is that correct? Yes.
[AGENT][NEUTRAL] OK, yes ma'am, I can help you with that, and [PII], do you also need eligibility or strictly just the benefits?
[CUSTOMER][NEUTRAL] OK, ma'am I can help you with that and do you also need the eligibility or strictly just the benefit? Eligibility as well please.
[AGENT][POSITIVE] Yes, ma'am. I can help you with that. And what is your callback number, please?
[CUSTOMER][NEUTRAL] Let's see if we can help you with that and what is your call back number please? [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] Thank you and the member's policy number please?
[CUSTOMER][NEUTRAL] Uh, policy number is.
[CUSTOMER][NEUTRAL] 02145412 M as in Mike L as in Lima 8.
[AGENT][POSITIVE] OK, thank you one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And any information, [PII] that I do provide would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Any information that I do provide would be a verification of benefits and not a guaranteed payment. What is your patient?
[CUSTOMER][NEUTRAL] [PII] and date of birth is [PII].
[AGENT][POSITIVE] OK, thank you one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I do say she is a dependent on the supplemental policy, [PII], and this policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] OK, so I'm sure she is a dependent on the supplemental policy, E, and the policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And on this policy, the outpatient benefit maximum per calendar year for covered outpatient services is $8000.
[CUSTOMER][NEUTRAL] And on this policy, the outpatient benefit maximum per calendar year for covered outpatient services is $8000. OK.
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person per calendar year.
[CUSTOMER][NEUTRAL] And there is no outpatient deductible for other person per calendar view.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now because this is a supplemental policy to the primary insurance, when the claim is submitted to APL for review, we must also receive a copy of the primary insurance company's explanation of benefits.
[CUSTOMER][NEUTRAL] Because this is a supplemental policy to the primary insurance when the claim is submitted to ACL for review, we must also receive a copy of the primary insurance company's explanation of benefits. OK.
[AGENT][NEUTRAL] And then once um the claim has been processed by us we do have a portal that you should be able to check our claim status in.
[CUSTOMER][NEUTRAL] And then once um the claim has been processed by us we do have a portal that you should be able to check our claim status in by going to [PII].
[AGENT][NEUTRAL] By going to [PII].
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, I see it here.
[AGENT][NEUTRAL] OK. And is there anything else that I can help you with this afternoon, [PII]?
[CUSTOMER][POSITIVE] Um, I think I have everything.
[CUSTOMER][NEUTRAL] That's it. If I can just get um the correct spelling of your name.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] That's it.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] Alright, OK. All right, Ms. [PII]. OK. Thank you very much. Have a good day. Yes, ma'am. Bye-bye.
[AGENT][NEUTRAL] Uh-huh, and you would use my name along with today's date as your call reference number.
[AGENT][POSITIVE] OK. Well, you're very welcome. Yes, ma'am. You too, and thank you again for calling APL. Uh-huh.
[AGENT][NEUTRAL] Bye-bye.