AccountId: 011433970860
ContactId: e05db191-a5b7-4110-a73e-e534c1d785ac
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 485079 ms
Total Talk Time (AGENT): 238848 ms
Total Talk Time (CUSTOMER): 104825 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/e05db191-a5b7-4110-a73e-e534c1d785ac_20250401T13:09_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is and I'm calling from Professional physical therapy.
[AGENT][NEUTRAL] I'm so I'm so sorry. Could you please sort of, I couldn't understand anything you said initially.
[CUSTOMER][NEUTRAL] OK, no problem. My name is [PII] and I'm calling from Professional physical therapy.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][POSITIVE] And I'm calling to follow up to get benefits on one of our patients.
[AGENT][NEUTRAL] OK. And you did say your name is [PII], is that correct?
[CUSTOMER][NEUTRAL] It's it's [PII].
[AGENT][NEUTRAL] OK, I'm sorry your voice is really muffled.
[AGENT][NEUTRAL] Can we try that one more time, please?
[CUSTOMER][POSITIVE] No problem. [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] All right. Thank you, [PII]. Thank you. And what is your callback number?
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And so you said you're needing to get eligibility and benefits for a member, is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes ma'am, I can help you. And what is the member's policy number [PII]?
[CUSTOMER][NEUTRAL] It's D like in dog.
[CUSTOMER][NEUTRAL] 412
[CUSTOMER][NEUTRAL] 03
[CUSTOMER][NEUTRAL] 549.
[AGENT][NEUTRAL] OK, now thank you TR but that is not an APO policy number. That would be a 90 degree or IMA benefit number.
[AGENT][NEUTRAL] Some of these members also have dual coverage with APO as well, but there should be another number on their ID card that's a policy certificate or policy cert number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you see that?
[CUSTOMER][NEUTRAL] All righty, so I have to pull the patient back. Oh, I don't have the card yet. She hasn't come in for her appointment, so I'm just trying to verify her benefits and provide her with the network or not. So I don't have the card, so I have to call the patient back.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, now, I can try by the name [PII]. I can't search by date of birth, but I can try and look it up by the name.
[AGENT][NEUTRAL] If it's a real common name, though that may be a challenge, but I'll be happy to try.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Her first name is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the last name is [PII].
[AGENT][NEUTRAL] I'm sorry, what's the last name?
[CUSTOMER][NEUTRAL] [PII], [PII]
[AGENT][NEUTRAL] OK. Are you saying [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And the next, and spell it again then.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. OK, thank you. One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What state does she live in?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so I do not find
[AGENT][NEUTRAL] Um, let me just look at this one.
[AGENT][NEUTRAL] Let me see if this is the one that we have um possibly. What is her date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. One moment. So I have located a policy for her, um, just one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so she has a limited benefit plan with APL.
[AGENT][NEUTRAL] And the policy number for us is 259.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 2661.
[AGENT][NEUTRAL] And it has an effective date TR of 127-25.
[AGENT][NEUTRAL] And on this limited benefit plan that she has, as far as you said this was for therapy.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, she only has benefits for an office visit.
[CUSTOMER][NEUTRAL] It
[AGENT][NEUTRAL] And the maximum benefit per visit on this limited benefit plan is $75.05 visits per calendar year.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] But for the treatment itself.
[CUSTOMER][NEUTRAL] So she can come into the office um.
[AGENT][NEUTRAL] Yes, uh, the treatment would not be covered under this plan. Now, for the other number that you gave me, that D number, again, that is a 90 degree or um IMA policy number. I can give you their phone number. I can also connect you with them if you would like.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Their number is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And it would be option one.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Now if you would like for me to connect you with them, I'll be happy to uh this plan participates, OK, this plan participates in the multi-plan network.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the phone number for multiplan is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So would you like for me to connect you to IMA or for or to multiplan?
[CUSTOMER][NEUTRAL] I guess the multipoint because that's what she said as well, so maybe they don't want to probably.
[AGENT][NEUTRAL] The multiplan for the network?
[CUSTOMER][POSITIVE] Yeah, you can try the my work plan, yeah.
[AGENT][NEUTRAL] OK, well, I'll be happy to connect you with them. So is there any and one last thing, we have a portal here at APL, so if you all do file a claim for her, once the claim has been processed, you should be able to check claim status by going to secured.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. Well, is there anything else that I can help you with before I connect you over to Multiplan?
[CUSTOMER][POSITIVE] All right, thank you.
[CUSTOMER][POSITIVE] No, thank you so much, [PII]. I appreciate your help.
[AGENT][POSITIVE] Well, you're welcome, [PII] and thank you again for calling APL. I hope you have a wonderful day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you. Mm bye-bye.
[CUSTOMER][NEUTRAL] So