AccountId: 011433970860
ContactId: b7f93a02-8707-43ca-b556-4b1707af8b05
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 146479 ms
Total Talk Time (AGENT): 62126 ms
Total Talk Time (CUSTOMER): 66363 ms
Interruptions: 2
Overall Sentiment: AGENT=1.5, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/b7f93a02-8707-43ca-b556-4b1707af8b05_20250520T19:35_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APO my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hi, I'm sorry, I missed your name.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII], hi, my name's [PII]. Um, I'm trying to get um physical therapy benefits in an office setting on a member.
[AGENT][POSITIVE] I'd be happy to assist with benefits today, [PII], if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] 4037
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] 02462081.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment.
[CUSTOMER][NEUTRAL] To be
[AGENT][NEUTRAL] I do show the policy is active, one moment.
[AGENT][NEUTRAL] Effective date is [PII].
[AGENT][NEUTRAL] And I do show for.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] The physical therapy that will be covered under the outpatient which is has a calendar year maximum of $5000.
[CUSTOMER][NEUTRAL] OK, that, so the, the benefit is a $5000 maximum?
[AGENT][NEUTRAL] For all outpatients.
[CUSTOMER][NEUTRAL] Or the out of pocket is a $5000.
[AGENT][NEUTRAL] No, that's the benefit amount.
[AGENT][NEUTRAL] So we're the gap
[CUSTOMER][NEUTRAL] OK, so he, he has.
[CUSTOMER][NEUTRAL] What does that mean?
[AGENT][NEUTRAL] Meaning we're his secondary you're gonna send the claim to his primary insurance first and when they apply any patient responsibility such as to his deductible or co-pay or co-insurance, then the claim is sent to us and then we're gonna process and pay up to that maximum.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Oh, OK, you'll pay up to $5000. OK, so he's got a deductible, so we're not gonna, so basically we're not gonna collect anything from him because United Healthcare will process and you guys will pick up that, um, 20% coinsurance.
[AGENT][POSITIVE] That's correct.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Up to, OK, so basically no patient responsibility. OK, um, can I get a reference number from you if you don't mind?
[AGENT][NEUTRAL] Reference is just my name [PII]. Last initial [PII], and the date and time of the call. Was there anything else I could assist with today?
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] Nope, I appreciate your help.
[AGENT][POSITIVE] Thank you for calling APL you have a good day.
[CUSTOMER][POSITIVE] Thanks you too bye bye.
[AGENT][NEUTRAL] Mhm. Bye bye.