AccountId: 011433970860
ContactId: df56b48b-78b1-48f0-bc71-2ee03068b8dd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 272000 ms
Total Talk Time (AGENT): 130437 ms
Total Talk Time (CUSTOMER): 84890 ms
Interruptions: 0
Overall Sentiment: AGENT=2, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/df56b48b-78b1-48f0-bc71-2ee03068b8dd_20250408T14:22_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Um, yes, I need to verify benefits for a patient, please.
[AGENT][POSITIVE] It would be my pleasure to assist you with eligibility and benefits. May I ask your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you, [PII] and a callback number, please.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you, [PII]. And what is the policy number for the patient, please, ma'am?
[CUSTOMER][NEUTRAL] 026 03723
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][POSITIVE] All right, thank you. I can help you with benefits and eligibility for necklets. [PII], I'm showing his policy is active.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Effective date is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And this is a limited indemnity policy. What type of benefits are you needing?
[CUSTOMER][NEUTRAL] Um, outpatient physical therapy bill by the facility.
[AGENT][NEUTRAL] OK. Now, they do.
[CUSTOMER][NEUTRAL] Outpatient hospital.
[AGENT][NEUTRAL] They do have physical, speech or occupational therapy facility benefits. We pay $30 per day, maximum of 4 days per calendar year. Now that is a verification of coverage and not a guarantee of payment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And none of that has been used so far for [PII]. Is there anything else I can help you with, [PII]?
[CUSTOMER][NEUTRAL] So you guys pay up to $30 and the patient is responsible for anything over that.
[AGENT][NEUTRAL] That's correct. Now if you're a multi plan provider, they are eligible for that discounted rate through multi plan. There's no contractual involvement in the processing of our claim.
[CUSTOMER][NEUTRAL] Um, so I'm not sure if we are or not, um.
[CUSTOMER][NEUTRAL] Kinda seem like we are, but I don't know for sure. Uh, is there any way you can.
[CUSTOMER][NEUTRAL] Look that up to see if we are.
[AGENT][NEUTRAL] So,
[AGENT][NEUTRAL] I don't have that information because um it doesn't affect the processing of our claim. Now when you send claims to the address um I don't know do you have that [PII] address on file?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For claims
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Hm
[CUSTOMER][NEUTRAL] You in [PII], uh.
[AGENT][NEUTRAL] When it when it goes to them if you are a um.
[AGENT][NEUTRAL] Multi-pla provider, they will rely reprice the claim and send that information to you and then they'll forward the claims to us for medical processing.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, OK, $30 per day, up to 4 days, correct.
[AGENT][NEUTRAL] Yes ma'am, per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And so um it doesn't, there's no actual visit limit, correct?
[AGENT][NEUTRAL] It's 44 visits, 4 days per calendar year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, and no authorization is required?
[AGENT][NEUTRAL] That is correct. We're not major medical, no authors are required.
[CUSTOMER][POSITIVE] Thank you so very much and what is the initial of your last name, [PII]?
[AGENT][NEUTRAL] [PII]. And if you need a reference number, it would be my name and today's date.
[CUSTOMER][NEUTRAL] Thank you and what type of plan is this again?
[AGENT][NEUTRAL] It's a limited indemnity policy.
[CUSTOMER][NEUTRAL] OK and um and you just say calendar year this is the calendar year plan.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, well thank you so very much that's all I need.
[AGENT][POSITIVE] Well, it's been a pleasure to assist you with those benefits. Is there anything else I can help you with before you go?
[CUSTOMER][POSITIVE] No, that's all for now thank you.
[AGENT][POSITIVE] Thank you for calling APL [PII]. I hope you have a wonderful day.
[CUSTOMER][POSITIVE] Thanks you too good bye.
[AGENT][POSITIVE] Thank you. Bye-bye.