AccountId: 011433970860
ContactId: de1f3d02-e230-4c27-9ea9-a3421db2794a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 330190 ms
Total Talk Time (AGENT): 162474 ms
Total Talk Time (CUSTOMER): 125522 ms
Interruptions: 4
Overall Sentiment: AGENT=0.9, CUSTOMER=1.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/23/de1f3d02-e230-4c27-9ea9-a3421db2794a_20250423T14:56_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from Children's Rehab in [PII], and I'm calling to find out the benefits of a patient for speech, occupational and physical therapies, please.
[AGENT][NEUTRAL] Sure, I can check those benefits for you. I'm sorry, you said your name was uh [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Oh [PII], sorry about that. OK.
[CUSTOMER][NEUTRAL] That's OK.
[AGENT][POSITIVE] And then [PII] can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure it's [PII].
[AGENT][NEUTRAL] Thank you and then do you have that policy number?
[CUSTOMER][NEUTRAL] I do. It is uh 261-523-8.
[AGENT][NEUTRAL] OK, and what was the name and date of birth for the patient, please?
[CUSTOMER][NEUTRAL] First name [PII], last name [PII]. Date of birth [PII].
[AGENT][POSITIVE] Perfect, thank you for verifying that. Uh, so this policy is active. Effective date was [PII].
[AGENT][NEUTRAL] And this is a limited indemnity medical plan. So in short, uh, take a set dollar amount per covered procedure, uh, or office visit. So bear with me just a moment. I will see if, um, occupational speech therapy is uh a covered benefit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] OK, uh, I appreciate your patience. Um, of course I will let you know verification of coverage is not a guarantee of payment for claims, uh, so physical speech or occupational therapy in a specialized facility, of course, um, with a covered benefit. This policy pays $30 per day for a maximum of 4 days per calendar year per covered person.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, so there's no outpatient benefits then.
[AGENT][NEUTRAL] That it's simply going to be that daily, um, maximum, so $30 per day for this kind of treatment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, but we're an outpatient, uh, facility where they don't stay.
[CUSTOMER][NEUTRAL] So they just come for their treatment and go home, so is that covered or no?
[AGENT][NEUTRAL] It's considered outpatient yes um so this falls under their um what's called uh outpatient accident and sickness uh treatment benefit and so that's what this falls under.
[CUSTOMER][POSITIVE] It is OK.
[CUSTOMER][NEUTRAL] OK, alrighty, and they get 4 days of each or combined?
[AGENT][NEUTRAL] Um, 4 days, uh, per calendar year per covered person.
[CUSTOMER][NEUTRAL] OK, so I'm still a little confused then. I understand it's per covered person, but if it's, uh, if they have speech one day, occupational the next day, or even on the same day, is that considered two or they just get that's OK.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Oh, I see.
[AGENT][NEGATIVE] Sorry, I know that is no, no, no.
[AGENT][NEUTRAL] No, I know it's confusing. OK, so yes, it does kind of group them all under the same category, so specifically for physical, speech or occupational therapy. So even if they do all in one day, it's going to be $30 for that day.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so it's 30 per day. OK, so it doesn't matter what they have on what day they just get 4 days' worth.
[AGENT][NEUTRAL] Correct, um, for this specifically, of course they have separate benefits for, you know, physician's office or urgent care this is simply under that one bucket, yes.
[CUSTOMER][POSITIVE] OK, perfect. OK.
[CUSTOMER][POSITIVE] You're right, yeah.
[CUSTOMER][POSITIVE] OK, alrighty, that's all I needed to know. Thank you so much.
[AGENT][POSITIVE] All right, yeah, thanks for giving us a call. I hope you have a great rest of your day. Thank you, you too. Yes.
[CUSTOMER][POSITIVE] You have a good day. Oh, could I ask one more question? Could you tell me your um.
[AGENT][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] Your billing address as well, do you know that that we could bill to we have it listed under American Public Life Insurance Company, but I'm not sure that's it. That's that's correct.
[AGENT][POSITIVE] Absolutely.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, right, um, so I have a mailing address, fax number and a payer ID.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect, that's great.
[AGENT][NEUTRAL] OK, so the mailing address I've got is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that is in [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, doke, perfect, and then if I just could have a payer ID that'd be great.
[AGENT][NEUTRAL] OK, and then
[AGENT][NEUTRAL] Sure, pay ID is 60801.
[CUSTOMER][POSITIVE] Perfect. OK, thank you so very much for all your help.
[AGENT][POSITIVE] Of course, yeah, thanks for giving us a call. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too, bye-bye.
[AGENT][NEUTRAL] Bye-bye.