AccountId: 011433970860
ContactId: c1563756-6ad2-41b8-a293-77bb3756f01c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 223919 ms
Total Talk Time (AGENT): 130156 ms
Total Talk Time (CUSTOMER): 59912 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/c1563756-6ad2-41b8-a293-77bb3756f01c_20250415T17:28_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling for uh physical therapy benefits. I'm calling from a provider's office.
[AGENT][NEUTRAL] OK, well, I can definitely help you with the physical therapy benefits and [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] direct line.
[AGENT][POSITIVE] Thank you. And the policy number whenever you're ready.
[CUSTOMER][NEUTRAL] Um, I have 02595525.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] I have [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. So I am showing the policy is active, it's been effective since [PII], and you said physical therapy benefits?
[CUSTOMER][NEUTRAL] Yes, for outpatient office setting.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so for physical speech or occupational therapy, um, you said, is it a so is a physical therapy facility or office?
[CUSTOMER][NEUTRAL] Office
[AGENT][NEUTRAL] So the reason I'm hesitating is because the member has a hospital indemnity policy. They do have coverage for physical, speech, or occupational therapy in the facility. If it's considered a physician office, um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The policy will pay up to $50 per day with a max of 4 days per calendar year.
[CUSTOMER][NEUTRAL] OK, so they would have to go to like a physical therapy facility within a hospital?
[AGENT][NEUTRAL] Um, well, it doesn't have to be within the hospital. It could be out, it could be attached, um, but
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] If, if they, if they do go to the physical therapy facility, the benefit is $30 a day with a max of $4 per calendar year. So, um, the in-office.
[AGENT][NEUTRAL] Applies more, but
[AGENT][NEUTRAL] Um, I don't, it depends on what you, what the coding comes in for us to determine if it's office or facility.
[CUSTOMER][NEUTRAL] OK, and would you be able to tell me if we're in network or out of network with their policy if I give you our tax ID?
[AGENT][NEUTRAL] Um, so we don't have like a list of providers or anything. Let me double check. So the hospital indemnity policy itself doesn't have any network, but they do have the or he does have the multi-plan uh PPO network. Um, I can give you the number or the website for multiplan if you want to see if you all are in network with that part of the policy. Uh, we just don't have access to the list of providers.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Gotcha. So it's just a general, uh, benefits information within their policy, correct?
[AGENT][NEUTRAL] Right.
[CUSTOMER][POSITIVE] OK, OK, thank you so much for your help. Can I have your name and a reference number?
[AGENT][NEUTRAL] Sure, so my name is [PII]. There is no call reference number, but you can use my name in today's date.
[CUSTOMER][POSITIVE] OK, thank you so much for your help you have a great day.
[AGENT][POSITIVE] Thank you, [PII]. You also, was there anything else I can help with?
[CUSTOMER][NEGATIVE] No thank you so much.
[AGENT][POSITIVE] Alright, thanks for calling API. You're welcome. Bye-bye.