AccountId: 011433970860
ContactId: 9d711833-6ec1-49b9-8d65-771d9f4fe50f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 234339 ms
Total Talk Time (AGENT): 101155 ms
Total Talk Time (CUSTOMER): 69775 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/9d711833-6ec1-49b9-8d65-771d9f4fe50f_20250121T15:52_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I was calling to verify benefits and eligibility.
[AGENT][NEUTRAL] OK. Is this for service in a doctor's office?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, what's the policy number?
[CUSTOMER][NEUTRAL] 0828763
[AGENT][NEUTRAL] And what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] The map there, OK.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], can you repeat the policy number?
[CUSTOMER][NEUTRAL] 0828763
[AGENT][NEUTRAL] OK. You, you, you cut out at the beginning of the number. Did you say 0828763?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I'm so sorry it's 01.
[AGENT][POSITIVE] OK, I missed the one. Thank you.
[CUSTOMER][NEUTRAL] Yep
[CUSTOMER][NEUTRAL] I just got him at [PII].
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Um, [PII] date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] We're going
[AGENT][NEUTRAL] And we're checking eligibility and office visit benefit, is that correct?
[CUSTOMER][NEUTRAL] Um, yeah, well, it's for hospital based outpatient physical therapy. Billing is a facility.
[AGENT][NEUTRAL] So, physical therapy, OK.
[AGENT][NEUTRAL] So the um effective date is [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I do show the policy is active at this time.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And the maximum outpatient benefit.
[AGENT][NEUTRAL] It's up to $5000 that is per calendar year.
[AGENT][NEUTRAL] Um, there is an outpatient deductible under this policy that would need to be satisfied first. Give me one moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And that outpatient benefits or deductible is.
[CUSTOMER][NEUTRAL] I was kind of like leave me alone.
[AGENT][NEUTRAL] $1000 per covered person per calendar year.
[AGENT][POSITIVE] And the physical therapy benefit.
[CUSTOMER][NEUTRAL] There
[AGENT][NEUTRAL] is up to 5000.
[AGENT][NEUTRAL] Per covered person per calendar year.
[AGENT][NEUTRAL] And that's for covered outpatient services and then the maximum for the family for all those that are covered is up to 10,000.
[AGENT][NEUTRAL] Per calendar year.
[CUSTOMER][NEUTRAL] OK, um, have they met any of that deductible? I'm assuming not.
[AGENT][POSITIVE] I'll, I'll check for you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I actually have
[AGENT][NEGATIVE] And deductible has not been satisfied. They've not met any of it.
[CUSTOMER][NEUTRAL] OK, um, their primary has a copay. I'm assuming you do not pick that up until the deductible has been met.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] OK wonderful um is there a visit limit or anything?
[AGENT][NEUTRAL] It's a $1 maximum?
[AGENT][NEUTRAL] Per calendar year.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then um can I just get a call reference number?
[AGENT][NEUTRAL] You'll use my name in today's date as your reference [PII].
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] [PII], first initial of my last name is [PII]. And any other questions I can assist with today, [PII]?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] No, that's it thanks so much [PII].
[AGENT][POSITIVE] All [PII]. Thank you for calling APL. Have a good day.