AccountId: 011433970860
ContactId: c3f9e8ea-4244-4577-bc9a-ecd754206734
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 233779 ms
Total Talk Time (AGENT): 116589 ms
Total Talk Time (CUSTOMER): 58829 ms
Interruptions: 1
Overall Sentiment: AGENT=1.9, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/c3f9e8ea-4244-4577-bc9a-ecd754206734_20250324T19:19_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello [PII], how are you? I'm inquiring about a patient's benefits.
[AGENT][NEUTRAL] OK, you're needing benefit information only, is that correct?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][POSITIVE] Yes, I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] Thank you. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] Callback number is gonna be [PII].
[AGENT][POSITIVE] Thank you and the member's policy number please.
[CUSTOMER][NEUTRAL] Uh member's policy number is going to be 02434460ML8.
[AGENT][POSITIVE] OK, thank you one moment please.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And any information that I do provide for you, this will be a verification of benefits and not a guarantee of payment. What is your patient's name please and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And do you need I'm sorry, inpatient, outpatient or office benefits?
[CUSTOMER][NEUTRAL] It would be outpatient benefits.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Specifically for uh physical therapy.
[AGENT][NEUTRAL] So on this policy, the outpatient um for covered outpatient services is $3000. I'm sorry, let me start over. Let me try that 11 more time, [PII], before I give you some incorrect information that's inpatient for outpatient the benefit max per calendar year for covered outpatient.
[CUSTOMER][POSITIVE] Yeah, no problem.
[AGENT][NEUTRAL] In Services is $1500 and there is no outpatient deductible per covered person per calendar year.
[AGENT][NEUTRAL] And when the claim is submitted to APO for review, you must also include a copy of the primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] And then once we have processed our claim we do have a portal in which you should be able to check claim status and our portal website is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And uh also uh from, from that 1500 outpatient, has any of that been used?
[AGENT][NEUTRAL] Yes, sir. Mhm.
[AGENT][NEUTRAL] I can check that for you. One moment.
[AGENT][NEUTRAL] And you are referring to this calendar year?
[CUSTOMER][POSITIVE] Uh, yes, correct.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] As of now, he has used $966.71.
[CUSTOMER][NEUTRAL] OK, so the remaining would be around $544 or so around there?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh what was your name again? Sorry.
[AGENT][NEUTRAL] [PII], and my name and today's date will be your call reference number.
[CUSTOMER][POSITIVE] Great
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you so much for your help, [PII]. I appreciate it.
[AGENT][POSITIVE] Well, well, you're very welcome. So is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] That you?
[AGENT][POSITIVE] OK, well then thank you again for calling ATO [PII] have a wonderful rest of your day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] I think