AccountId: 011433970860
ContactId: a8f7b775-2a12-4cfd-ba59-2cef523aeb41
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 260988 ms
Total Talk Time (AGENT): 86631 ms
Total Talk Time (CUSTOMER): 54384 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/a8f7b775-2a12-4cfd-ba59-2cef523aeb41_20250514T14:43_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good morning. I'm sorry, did you say [PII] or [PII]?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] How you doing this morning, Ms. [PII]?
[AGENT][NEUTRAL] Doing all right how are you?
[CUSTOMER][POSITIVE] I'm doing well. I was hoping to get benefits and eligibility on a member, please.
[AGENT][NEUTRAL] Yeah, I could check eligibility and benefits for you. Um, what was your name please?
[CUSTOMER][NEUTRAL] [PII], just the letters um [PII] is the first letter to my last name.
[AGENT][NEUTRAL] OK, you said [PII] like the both the letter, the letters?
[CUSTOMER][NEUTRAL] Yes ma'am, just the waters.
[AGENT][NEUTRAL] OK, got you, and then, uh, can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] It's a direct line. It's [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you. And then do you have that policy number?
[CUSTOMER][NEUTRAL] It's 01997051.
[AGENT][NEUTRAL] OK, and then what was the name and date of birth for the member, please?
[CUSTOMER][NEUTRAL] [PII] I don't know how to say the last name uh [PII].
[AGENT][NEUTRAL] OK, bear with me just a moment. I'm sorry, um.
[CUSTOMER][NEUTRAL] Mercato.
[AGENT][NEGATIVE] Gotta reboot this program. Give me just a minute, sorry.
[CUSTOMER][POSITIVE] Mhm, no worries.
[AGENT][NEUTRAL] Goodness, there we are. Alright, I'm so sorry about that. OK, um, alright, got it up. I appreciate you verifying that. So the policy is active, uh, 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 and uh we we need to look at inpatient or outpatient benefits for this member.
[CUSTOMER][POSITIVE] No worries.
[CUSTOMER][NEUTRAL] Outpatient physical therapy done in an office.
[AGENT][NEUTRAL] Physical therapy benefits, OK.
[AGENT][NEUTRAL] Let me make sure that is a covered benefit under this policy. One moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] It is really thinking about it this morning. I'm so sorry for the wait.
[CUSTOMER][POSITIVE] No, no, take your time no worries.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Come on
[CUSTOMER][NEUTRAL] And you did say that this policy is the secondary, right?
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So of course I will let you know verification of coverage is not a guarantee of payment for claims. So physical therapy is a covered benefit under their outpatient benefits. However, it does specify when it is performed in phys.
[CUSTOMER][NEUTRAL] I'm sorry you broke up hello?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello?