AccountId: 011433970860
ContactId: e11652bd-5b49-4ede-b23e-787c6be328f4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 246160 ms
Total Talk Time (AGENT): 98739 ms
Total Talk Time (CUSTOMER): 91527 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/e11652bd-5b49-4ede-b23e-787c6be328f4_20250113T15:31_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] and I am calling to get this patient's benefits for outpatient physical therapy.
[AGENT][POSITIVE] OK, yeah, I can definitely look at some outpatient physical therapy benefits for you today. Do you mind if I grab a good callback number from you real quick?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][POSITIVE] Wonderful. And the member's policy number?
[CUSTOMER][NEUTRAL] Um, 02567206.
[AGENT][NEUTRAL] All right, and give me just a moment to
[AGENT][NEUTRAL] Pull that up.
[AGENT][POSITIVE] And I'm so sorry.
[CUSTOMER][NEUTRAL] You're fine.
[AGENT][NEUTRAL] Could you verify for me pretty please your patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Mhm. Uh, [PII], [PII].
[AGENT][POSITIVE] Perfect. Um, Ms. [PII] is current and active. It looks like her effective date is [PII] and
[AGENT][NEUTRAL] Let me look at some benefits for you.
[AGENT][NEUTRAL] All right, it does like look like Ms. [PII] has um
[AGENT][NEUTRAL] A benefit for outpatient physical therapy. It's listed under injury and sickness, and she has 4 visits a year she can use for up to $30 a visit. Granted, that is just a verification of coverage and never guaranteed payment.
[CUSTOMER][NEUTRAL] So, OK. So you're saying that you guys will only pay $30 of the visit or the patient is responsible for $30?
[AGENT][NEUTRAL] Um, our benefit, we will only pay up to $30.
[AGENT][NEUTRAL] It's a limited hospital indemnity policy, so it's a supplemental plan.
[CUSTOMER][NEUTRAL] $30 for a visit. All right, does it show that she's used any of those visits? Because, and I don't know, is this on a calendar year or did this start like in November?
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] It is on the calendar year. Let me see if I can see any benefits use this calendar year yet.
[AGENT][NEUTRAL] I don't see anything used this calendar year so far.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Because when I called on Friday to verify her benefits and I spoke with somebody named [PII].
[CUSTOMER][NEUTRAL] Um, they told me that there were no physical therapy or no therapy benefits of any kind. So they were probably not looking under injury or sickness. So you think that was the, the problem?
[AGENT][NEUTRAL] Um, I wonder, I don't, I don't know what they were looking at, um, but I see it right here, it says PT right next to it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So,
[CUSTOMER][NEUTRAL] All right, um.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] I guess I don't need to know what deductibles and all that is if that's all they're if if that's just the way this works um.
[CUSTOMER][NEUTRAL] And that's a hard max that's 4 visits.
[AGENT][NEUTRAL] 4 visits a year up to $30 per visit, yep.
[CUSTOMER][NEUTRAL] OK, all right, can I get the spelling of your name and the reference number?
[AGENT][NEUTRAL] Yeah, it's [PII] The reference number is my name, [PII], last initial [PII] and today's date.
[CUSTOMER][POSITIVE] All right, thank you so much, [PII]. You have a great day.
[AGENT][POSITIVE] Hey my pleasure thank you so much for calling us. You have a wonderful day as well.
[CUSTOMER][NEUTRAL] Mhm bye bye.
[AGENT][NEUTRAL] Bye bye.