AccountId: 011433970860
ContactId: beb37b37-7974-47ff-a0c0-5cb10e7b8de2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 246770 ms
Total Talk Time (AGENT): 170934 ms
Total Talk Time (CUSTOMER): 67719 ms
Interruptions: 2
Overall Sentiment: AGENT=1.3, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/beb37b37-7974-47ff-a0c0-5cb10e7b8de2_20250219T18:19_UTC.wav
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[AGENT][NEUTRAL] Afternoon. Thank you for calling APL. This is [PII]. How may I help you today?
[CUSTOMER][NEUTRAL] Hello, I'm calling from a provider's office and I need benefits for a member.
[AGENT][POSITIVE] OK, I'd be glad to help you. Go ahead and give me your name and the member's policy number, please, ma'am.
[CUSTOMER][NEUTRAL] It's [PII] and it's 02587816 ML 8.
[AGENT][POSITIVE] Alright Bus, thank you so much for that information. Now while I'm pulling this up, go ahead and give me a good return telephone call number please, ma'am.
[CUSTOMER][POSITIVE] Awesome.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][POSITIVE] Alrighty Bill, because thank you so much for all that information. Now your patience, name and date of birth today, please, ma'am.
[CUSTOMER][NEUTRAL] It's [PII] and it's [PII].
[AGENT][NEUTRAL] Alright, thank you for that, Bill, because it looks like [PII] is the insured on this medical supplemental plan. I do show her original effective date is [PII]. She is current and active, but I must advise that verification of coverage is not a guarantee of payment on a claim, but you did say you want some type of benefit. Is that correct, Bus?
[CUSTOMER][NEUTRAL] Yes, this is gonna be for um physical and occupational therapy being done in the specialist office.
[AGENT][NEUTRAL] OK, let me go pull the benefit plan up real quick. Now, what we are, of course, is her medical supplemental plan, so the only thing that we would pick up and pay on is anything that is applied towards her deductible co-pay or co-insurance at her primary insurance carrier. Now, we don't pay for anything routine here at all, no matter what. Occupational therapy is not covered here at all.
[AGENT][NEUTRAL] I can tell you that and I'm gonna check to make sure about physical therapy, so hold on just a moment for me while I pull up this benefit plan. Computer is a little slow today. I guess it knows it's cold.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's OK.
[AGENT][NEUTRAL] They just don't want to move. I know, so bear with me a moment, [PII], because let's see, I think, I think it's moving now.
[AGENT][NEUTRAL] Oh, well, let's see.
[AGENT][NEUTRAL] It's like they have a mind of their own.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, let's see now, it looks like under the outpatient benefit here, it's a zero deductible, no pre-start for physical therapy, and she would have a $3000 benefit payable per calendar day and no pre-cert required.
[AGENT][NEGATIVE] But the occupational therapy is not going to be covered here at all.
[CUSTOMER][NEUTRAL] OK, so that $3000 is is per day?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Per calendar day, yes, ma'am.
[CUSTOMER][NEUTRAL] Wow. Has she used any?
[AGENT][NEUTRAL] Um, it's per calendar day, so whatever the date of service is, it's gonna be that per calendar day benefit.
[CUSTOMER][POSITIVE] Wow.
[AGENT][POSITIVE] She's got that every day. Yes, she's got a super fantastic plan.
[CUSTOMER][NEUTRAL] She does.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Is that all I can help answer for you today, [PII]?
[CUSTOMER][NEUTRAL] Uh, yeah, let me ask you, is that still remaining? I mean, has she used any or no?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, ma'am, that's a per calendar day benefit. So if she goes to the doctor tomorrow for physical therapy, that's her per calendar day. Every day she has that max. Yeah, but she's not used any cause it it's per calendar day.
[CUSTOMER][POSITIVE] Wow. Oh boy. OK, OK.
[CUSTOMER][NEUTRAL] It's per day. Wow. OK. Um, that's all. What what was your name again?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] My name is [PII] and that is spelled [PII]
[CUSTOMER][POSITIVE] [PII]. Thank you, [PII]. Um, that will be all. You have a great day.
[AGENT][NEUTRAL] Yes, ma'am. Yes, ma'am.
[AGENT][POSITIVE] OK. Well, you as well, [PII] and thanks for calling APL. Have a great rest of your day as well. Bye-bye.
[CUSTOMER][POSITIVE] Thanks you too bye bye.