AccountId: 011433970860
ContactId: cc0455cd-3135-4ee4-9c71-910761ed4c14
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 434980 ms
Total Talk Time (AGENT): 178890 ms
Total Talk Time (CUSTOMER): 124266 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/cc0455cd-3135-4ee4-9c71-910761ed4c14_20250512T19:07_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, [PII], uh, my name's [PII]. I'm from, uh, SSM Saint Mary's Hospital physical therapy department, and I am wanting to see benefits and if I need a prior off for a patient for physical therapy outpatients.
[AGENT][NEUTRAL] OK, yeah, let's take a look, [PII]. What is the patient's policy number?
[CUSTOMER][NEUTRAL] It is let me pull this up. It is 56,935,645,600.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so that's a little long for one of our policy numbers. Do you have their card in front of you?
[CUSTOMER][NEUTRAL] Uh, let me look and see if I can.
[CUSTOMER][NEUTRAL] Let me look here.
[CUSTOMER][NEUTRAL] And insurance's see if this is it.
[CUSTOMER][NEUTRAL] Alright, so I've got a policy number. I don't know why they had all that one on the chart. Uh, it is 02573785.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] Oh to fix that.
[AGENT][NEUTRAL] And what is the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] It is [PII] and date of birth is [PII].
[AGENT][POSITIVE] Thank you so much. So patient is active. Uh, effective date is [PII] or excuse me, I was about to give you date of birth.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The effective date. Oh, effective date is [PII].
[CUSTOMER][POSITIVE] OK, we're on the, we're on the page.
[AGENT][NEUTRAL] Yeah, we're there, we're there. All right. Um, outpatient physical therapy. Member has a limited benefit hospital indemnity plan. So let me see what this is gonna cover under their outpatient.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I just wanna make sure. They do have an outpatient writer for um an office visit with a physician. It does show a benefit amount of $75 and the patient's allowed up to $5 a year. We just wanna make sure that that would include physical therapy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, um.
[AGENT][NEUTRAL] So it doesn't say anything specifically about physical therapy.
[AGENT][NEUTRAL] There's nothing that I see under, there's no exclusions. It does say that it covers, it covered sickness in a physician's office, urgent care, or emergency room. So physical therapy may not be a benefit under this.
[CUSTOMER][NEUTRAL] So I'm wondering if she has any.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I mean, it doesn't say anything under the exclusions about it not being.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Yeah, so honestly, the way that I read this is that it's just for sickness, not any sort of like injury. So I would lean more towards, this is just for hospital and doctor's office visits. There's not any coverage for any physical therapy on here.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, so no PT coverage.
[AGENT][NEUTRAL] Yeah, not that I see that is definitive that I would be comfortable saying yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Right, right, yeah, first time.
[CUSTOMER][NEUTRAL] And in the office, so, oh, OK, alright, so she doesn't have any physical therapy coverage. I'll just put that in there.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you check the CPT codes, see if that pulls up anything? I wonder.
[AGENT][NEUTRAL] Um, we don't have any way to check a CPT.
[CUSTOMER][NEUTRAL] OK, I just wondered if it would, you know, flag something. Oh yeah.
[AGENT][NEUTRAL] Um.
[AGENT][NEUTRAL] Yeah, no, unfortunately not. I mean, with the limited benefit plans, it's not major medical, so I wouldn't be.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] Yeah, I wouldn't be surprised if it's not a covered benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, alright, I'll speak with her and just see if she can figure it out from there right and can I get your name and a reference number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, absolutely. Call reference is my name with my last initial and then today's date. My name is [PII] and that is spelled [PII] My last initial is [PII], and then today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, and it is [PII]. Alright, got it, and I'll just speak with the patient and we'll go from there.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Sounds good thanks for calling APL have a great day.
[CUSTOMER][POSITIVE] OK, uh thank you.