AccountId: 011433970860
ContactId: ca56d7bf-f050-483a-b87e-82e0ec212be4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 282720 ms
Total Talk Time (AGENT): 101562 ms
Total Talk Time (CUSTOMER): 57010 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/ca56d7bf-f050-483a-b87e-82e0ec212be4_20250123T17:46_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], um, my name's [PII]. I'm needing help getting benefits for a member please.
[AGENT][NEUTRAL] OK, Miss [PII], I can help you with benefits. Can you please give me the insured's name?
[AGENT][NEUTRAL] Uh, the patient's name?
[CUSTOMER][NEUTRAL] Yes, it's uh huh, it's [PII] and the last name is [PII]
[AGENT][POSITIVE] OK. Thank you so much. And then what is the insured's
[AGENT][NEUTRAL] Date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the policy number, please?
[CUSTOMER][NEUTRAL] I have 02363909.
[AGENT][NEUTRAL] OK, let me look that policy up.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, I do show the insured does have an active policy. The effective date is [PII].
[AGENT][NEUTRAL] And this is just to verify coverage. It's not a guarantee of payment. She has a supplemental insurance policy that is billed secondary to her primary, and it helps with deductible, co-pay, and co-insurance. She has an inpatient benefit amount of $5000 per calendar year, and she also has an outpatient benefit amount of $5000 per calendar year.
[CUSTOMER][NEUTRAL] OK, and this would be for outpatient physical therapy, so I'm assuming it would just be that excuse me, that 5000.
[CUSTOMER][NEUTRAL] For the hospital?
[AGENT][NEUTRAL] Right. Right. Let me look and see, um, it would be considered physical therapy. So let me pull up her policy and see if physical therapy is covered under her plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's gonna be just a sec while the computer pulls it in for me.
[AGENT][NEUTRAL] OK, now I'm searching to see if I can find it on her policy real quick.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Yes, physical therapy is um covered on her policy.
[AGENT][NEUTRAL] Um, if done in an office, center or clinic in which a licensed physical therapist provides physical therapy.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And do you know if they've used any of that 5000 this year?
[AGENT][NEUTRAL] Let me check for you real quick.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] No, ma'am. Nothing's been used for this year.
[CUSTOMER][POSITIVE] OK great.
[CUSTOMER][NEUTRAL] And do you guys require like any orders, authorizations or anything?
[AGENT][NEUTRAL] No, ma'am, because we're not the primary.
[CUSTOMER][POSITIVE] OK great.
[CUSTOMER][NEUTRAL] And do you have a reference number please [PII]?
[AGENT][NEUTRAL] Yes, ma'am, you can use my name.
[AGENT][NEUTRAL] And today's date.
[CUSTOMER][POSITIVE] All right thank you so much for all your help.
[AGENT][POSITIVE] You're very welcome you have a good day and thanks for calling APL.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Thanks you too bye bye.