AccountId: 011433970860
ContactId: dd12847e-7ac3-4066-a8ea-61c317005330
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 383559 ms
Total Talk Time (AGENT): 89026 ms
Total Talk Time (CUSTOMER): 135642 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/dd12847e-7ac3-4066-a8ea-61c317005330_20250409T19:54_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, hi, this is [PII] from AdventHealth.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yeah. Hi. Uh, I need to check a patient eligibility and benefits.
[AGENT][NEUTRAL] OK, [PII], do you have a good callback number?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[CUSTOMER][NEUTRAL] [PII] and it's a direct line.
[AGENT][NEUTRAL] And the policy number of the patient?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh sorry?
[AGENT][NEUTRAL] Policy number of the patient?
[CUSTOMER][NEUTRAL] Yeah, just a moment.
[CUSTOMER][NEUTRAL] Uh, just a moment.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, thank you for your patience. Actually, it's a supplementary plan, so I don't have a, a member plan, uh, sorry, member ID. Uh, could you please
[CUSTOMER][NEUTRAL] Uh, check with patient name and uh date of birth.
[AGENT][NEUTRAL] OK, what's the name? Last name?
[CUSTOMER][NEUTRAL] Yeah, it's, it's [PII] and date of birth is [PII].
[AGENT][NEUTRAL] And what was the last name? How do you spell it?
[CUSTOMER][NEUTRAL] Yeah, it's [PII]
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] OK, give me one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] I'm not
[CUSTOMER][NEUTRAL] I told him.
[AGENT][NEUTRAL] OK. And what was the date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And you needed eligibility and benefits, is that correct?
[CUSTOMER][NEUTRAL] Yes, uh, for a physical therapy than an outpatient hospital.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] This is not a guarantee of payment. It's a basic outline of the policy. The effective date of the policy is [PII]. Policy is currently active, no term date.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] I'm pulling up the benefits, hold on one moment.
[CUSTOMER][NEUTRAL] Yeah. Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And for physical therapy benefits in the hospital, it is a benefit of $2000 per calendar year per covered person.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] A deductible for an individual person is uh $2000 right?
[AGENT][NEUTRAL] No, it's, there's no deductible. It will pay after the primary processes the claim, if there's any deductible, co-pay or co-insurance left over, this policy will pay up to $2000 in a calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] After the primary insurance, uh, for the patient.
[CUSTOMER][NEUTRAL] This will pay $2000 for a calendar year, right?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah. Um, may I know, uh, if there is any visit limits for, uh, physical therapy?
[AGENT][NEUTRAL] Um, no, there's no limits, just that dollar amount.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, sorry, it's for occupational therapy. Uh, is there any visit limit for occupational therapy?
[AGENT][NEUTRAL] OK, so it's it's not physical therapy?
[CUSTOMER][POSITIVE] Yeah, it's an occupational therapy. Sorry for that.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Um, it looks like the plan does not have any coverage for occupational therapy.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK. For this patient, occupational therapy is not covered, right?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yeah, thank you for your kind assistance. Uh, could you please spell your name along with the last name initial?
[AGENT][NEUTRAL] My name is [PII]. It's [PII] First initial to last name is [PII], and then today's date with my name is the reference number.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yeah, thank you for your assistance, [PII]. Have a great day. Bye-bye.
[AGENT][POSITIVE] Thank you, thank you for calling APL you too.
[CUSTOMER][NEUTRAL] OK.