AccountId: 011433970860
ContactId: e8cadb09-fcef-482f-a92c-0d848ed1c654
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1195119 ms
Total Talk Time (AGENT): 357024 ms
Total Talk Time (CUSTOMER): 594404 ms
Interruptions: 4
Overall Sentiment: AGENT=0.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/17/e8cadb09-fcef-482f-a92c-0d848ed1c654_20250317T12:23_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey [PII], good morning. It's [PII]. So I had um
[AGENT][POSITIVE] Good morning.
[CUSTOMER][NEUTRAL] Well, my claim and everything went through a question I have for you. My rep, of course, does not respond again. Uh, the doctor, my orthopedic doctor prescribed physical therapy. My book here that I have in front of me.
[CUSTOMER][NEUTRAL] The way I read it, it says it covers up to 6 sessions. Can we see what, what, if that would be um flammable, please?
[AGENT][NEUTRAL] OK, what's the policy number, [PII]? I can help you.
[CUSTOMER][NEUTRAL] Um, don't have that. I give you my social [PII] and that's less social which the policy is under. That's for accident.
[AGENT][NEUTRAL] OK, and what's the a good callback number for you in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you. Well, uh-huh.
[CUSTOMER][NEUTRAL] I thought, yeah, I thought I was done with it, but he, he says that I can't walk right. I need physical therapy.
[AGENT][NEUTRAL] OK. So we're checking physical therapy.
[CUSTOMER][NEUTRAL] Uh-huh. For an accident with a broken foot. It was a broken uh fibular bone.
[AGENT][NEUTRAL] OK, let me pull up
[CUSTOMER][NEUTRAL] Uh, everything went through, but now this is, you know.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEGATIVE] I don't want to go there, but I literally can't walk right. I fall over when I step on the foot, so.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] See.
[CUSTOMER][NEUTRAL] What I have now was a close that benefits guidebook.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] But maybe you can
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] And faster.
[AGENT][NEUTRAL] Yeah, let's see.
[AGENT][NEUTRAL] Verify your date of birth for me.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And now the claim is
[CUSTOMER][NEUTRAL] And that is pertaining my accident on [PII], yes.
[AGENT][NEUTRAL] This is for
[AGENT][NEUTRAL] OK, alright, so it's for you. OK, give me a second.
[CUSTOMER][NEUTRAL] Look at I see this thing.
[AGENT][NEUTRAL] And you're just wanting me to check the policy to see if physical therapy is covered?
[CUSTOMER][NEUTRAL] Yes, when I go there and then what, what do I need if it is? I mean, what do I need to get something to you, of course, I mean something.
[AGENT][NEUTRAL] Under the accident.
[AGENT][NEUTRAL] Uh, let's see.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm pulling up your policy now.
[CUSTOMER][NEUTRAL] You know what, I had it up here this morning looking in the book. I can't find it now, um.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Just wanna make sure that we do the same thing here.
[AGENT][NEUTRAL] Mhm. So I'm on the schedule page.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see which is on page 6.
[CUSTOMER][NEUTRAL] I don't even know if I have the correct guidebook here.
[AGENT][NEUTRAL] You mean the correct the policy? OK.
[CUSTOMER][POSITIVE] This benefit guide book, yeah, for for the benefit guidebook for 24 I have.
[AGENT][NEUTRAL] Is it a policy that you have though, or what are you, are you looking at your, your policy?
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] No, I don't even have anything. It, it's, yeah, it says APL group accident insurance, I guess that would be it, right?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] So something this morning that
[CUSTOMER][NEUTRAL] It said, physical therapy.
[CUSTOMER][NEUTRAL] Gosh.
[AGENT][NEUTRAL] I'm still looking.
[CUSTOMER][NEUTRAL] That's right, I just don't know.
[CUSTOMER][POSITIVE] So much preventative care and I'm so.
[CUSTOMER][NEUTRAL] Basically, I have the script from the orthopedic doctor and I have set up my
[CUSTOMER][NEUTRAL] First appointment today with
[CUSTOMER][NEUTRAL] Physical therapy.
[CUSTOMER][POSITIVE] Uh, truthfully, I hope they can help me a little bit here.
[CUSTOMER][NEUTRAL] Because I don't know what else to do, but at the same time,
[CUSTOMER][NEUTRAL] You know
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] I'm still looking.
[CUSTOMER][NEUTRAL] I saw some said physical therapy for 6, I would imagine 6 sessions it was.
[AGENT][NEUTRAL] Was it under the accident policy or one of your other policies?
[CUSTOMER][NEUTRAL] Yeah, accident.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Group accident insurance. It says
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, it says therapy benefits, physical therapy dollar 60 6 days.
[AGENT][NEUTRAL] Mhm. What?
[CUSTOMER][NEUTRAL] And then it says plan plan that's plan one insured insured benefit and then there's a plan B insured and a benefit I can read it that morning. It says 120/6 days.
[AGENT][NEUTRAL] What
[AGENT][NEUTRAL] And now are you looking at the document when you enrolled or are you looking at the actual, you do not have the policy document? Because that's what we need to look at.
[CUSTOMER][NEUTRAL] No, it's
[AGENT][NEUTRAL] Are you looking like at a brochure?
[CUSTOMER][NEUTRAL] No, it's just a group.
[CUSTOMER][POSITIVE] Yeah, it's a book. It's a benefits guidebook for [PII] for [PII].
[CUSTOMER][NEUTRAL] Under APL Group accident insurance.
[CUSTOMER][NEGATIVE] There's a plan 1 and plan 2, that I don't understand at all why we have a plan 1 and plan 2 and everything says exactly the same except plan 2, the dollar amounts are higher.
[AGENT][NEUTRAL] That would be the difference. Let me see what plan you have.
[CUSTOMER][NEUTRAL] Meaning
[CUSTOMER][NEUTRAL] Right, but
[CUSTOMER][NEUTRAL] OK, can we find out?
[AGENT][NEUTRAL] So you're on 2, you're on plan 2.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let's see
[CUSTOMER][NEUTRAL] You can see that. OK. And then it says.
[AGENT][NEUTRAL] Yeah, I see that you are on plan 2. Did you see physical therapy under plan 1 or plan 2?
[CUSTOMER][NEUTRAL] I see it on both, it says therapy benefit, physical therapy, [PII]an 1 is 60 for 6 days, Plan 2 is 120 for 6 days. I'm assuming that means 6 sessions, right?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so physical therapy. Let's see.
[CUSTOMER][NEUTRAL] I mean, I'm not, you know, 6 days means 6 therapy days.
[CUSTOMER][NEUTRAL] So is a plan to for me and my husband, or rather my husband and I, myself, because he's the insured person.
[CUSTOMER][NEUTRAL] I'm, I'm the uh
[AGENT][NEUTRAL] Yeah, you're both on this accident policy.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] I'm still looking though for the benefit.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Under the policy.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I do see it under your policy.
[AGENT][NEUTRAL] So I'm looking at the benefit, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It does say that it's 6 days and that's per calendar year per or actually per plan year per covered person.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] So in the document that you're looking at, does it say per calendar year or per plan year?
[CUSTOMER][NEUTRAL] It doesn't say anything.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It just says plan 2 insured benefit.
[CUSTOMER][NEUTRAL] 120/6 days.
[AGENT][NEUTRAL] And then it says
[CUSTOMER][NEUTRAL] And the other one said 60/6 days.
[AGENT][NEUTRAL] OK, so it says that therapy must occur within.
[AGENT][NEUTRAL] 90 days from the date of the accident. When was the accident?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] We're in the time frame.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Cause I just got 66 weeks of um
[CUSTOMER][NEUTRAL] The uh walking device.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][MIXED] And that was all paid out and that's appreciated. But now, I, I wasn't expecting the therapy. I thought, OK, 6 weeks, it's gonna come off. I get in my shoe and I can walk, but I can literally, I can't move my foot. I can't.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] I mean, I can when I'm sitting, I'm doing, but I can't stand up and walk, even with the crutches or the walker or whatever. I can't. So the orthopedic uh last Thursday, I saw him.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] He says he highly recommends or suggests or wants me to do physical therapy. Uh, that depends on improvement, you know, what I
[CUSTOMER][NEUTRAL] How I improve.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Hopefully I improve this help. I mean, they are professionals. I'm just.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] A person with a broken foot that tries to have no broken foot, um.
[AGENT][NEUTRAL] So the benefit amount uh for the spouse, it says it's $90. It is 6 calendar days, I mean 6 days per covered person per plan year.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the reimbursement for the spouse is $900.
[CUSTOMER][NEUTRAL] So, so what do I have to do to claim that then? Do I get something from the physical therapist or the, the uh place I'm going every time or should I wait for days? OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, it's a, it's, yeah, it's the same thing. It's an, you will need to get an itemized bill.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] From the physical therapy facility wherever you're having it done and then we also would need the accident claim form completed.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK, so it's same thing, OK.
[AGENT][NEUTRAL] And the same thing. And so make sure make sure that your diagnosis code and your procedure codes and the charges and all of that is on the itemized bill like before.
[CUSTOMER][NEUTRAL] And, OK, go ahead.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, the physical therapist, they would have that, correct? I mean,
[AGENT][POSITIVE] So there won't be a delay.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That office, yes, you'll request the just let them know that you're needing to file an itemized bill, a fully itemized bill, um, and if they could provide you with a copy of it and you wanna make sure to let them know that it, it needs to have your diagnosis code on there and any procedure codes, probably physical therapy procedure codes, of course, to charge the name of the, you know, facility.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then um and then you can also do you have a copy of the accident claim form? Or do I need to send you email you one?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Can you, can you send me one, please, in the mail?
[AGENT][NEUTRAL] OK. You want me to send it in the mail? I can do that.
[CUSTOMER][NEUTRAL] Yeah, yeah, would you please?
[AGENT][NEUTRAL] And go ahead and verify your address for me to make sure.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Yep.
[AGENT][NEUTRAL] That is what I show, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK. Now, I'm jumping the gun here. I, I know I will because I'm a very strong-willed person, strong-minded. I will walk normally again, OK?
[AGENT][NEUTRAL] Oh, you will, right.
[CUSTOMER][NEUTRAL] But, but when I'm looking under the group accident insurance, this is auto home, auto and home modification. Does that mean I can claim if I would have to, I have, I, I have steps. I'm walking down 8 steps from my entry door to my driveway where I'm walking to get out of here. So if I would need something modified, like, say, a ramp, if I would build a ramp or something.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] You know where you can just walk down instead of stepping down?
[AGENT][NEUTRAL] Mhm. Mhm.
[CUSTOMER][NEUTRAL] It says 1000 1 time and again plan one insured benefit, plan 1 insured benefit. I don't know why it's listed twice, but one says.
[AGENT][NEUTRAL] Your plan too though, look under plan 2.
[CUSTOMER][POSITIVE] I'm playing too.
[CUSTOMER][NEUTRAL] Just only playing one.
[AGENT][NEUTRAL] And so, what is the benefit? What, what, what are you needing?
[CUSTOMER][NEUTRAL] It says.
[CUSTOMER][NEUTRAL] It says group accident plan one insured benefit. It says home and auto modification. I'm assuming if you can't.
[CUSTOMER][NEUTRAL] Use your vehicle the way you used to, and
[CUSTOMER][POSITIVE] I actually could because it's my right foot. I'm not trying to modify my vehicle by heavens no. Home modification, would that be uh to build something I can get out of the house easier?
[AGENT][NEGATIVE] Oh, no, that isn't covered. No, that would not be covered.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] OK, what, what does auto and home modification mean?
[CUSTOMER][NEUTRAL] It says under other benefits.
[AGENT][NEUTRAL] I don't
[AGENT][NEUTRAL] OK, I don't, are you look and you're looking at a plan too? Oh, I see it. I see it. Give me one second. Let me look at the definition of that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Auto and home modifications one moment.
[AGENT][NEUTRAL] Just take me a few minutes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][MIXED] This book is semi-helpful but not really, you know what I mean?
[AGENT][NEUTRAL] Mhm. How did you, how did you injure your foot?
[CUSTOMER][NEUTRAL] I fell on, it was an accident. I fell on the ice and I was walking and yeah.
[AGENT][NEUTRAL] I remember that. Mhm.
[CUSTOMER][MIXED] And that was all done and, and paid for, and I really appreciate it because I needed help, money for somebody to help you. But um that's all good, but now, again, I wasn't even expecting to be sent to physical therapy either.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And now, as it's, I mean, it's only a week now since the walking boot.
[CUSTOMER][NEUTRAL] is in question, should I or should not, I not wear that. But um
[CUSTOMER][NEGATIVE] Now, since she says, well, he can't do anything with my foot not working properly.
[CUSTOMER][NEGATIVE] It scares me, you know, and I'm, I'm assuming they will help me.
[CUSTOMER][NEUTRAL] I mean, that's what they are there for, right? They learn that.
[CUSTOMER][NEUTRAL] The physical therapist.
[AGENT][NEUTRAL] I'm sorry, what was that, Carmen?
[CUSTOMER][NEUTRAL] The, the, uh, that you was looking at that modification, what, what that means, but um.
[AGENT][NEUTRAL] Mhm. Yeah, I'm still reading.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. Probably a long paragraph, right?
[AGENT][NEUTRAL] Not quite.
[AGENT][NEUTRAL] OK, so under the auto and home modification, it says that we will pay the auto and home modification benefit amount shown in the schedule of benefits if it's, if as a result of a covered accident, a covered person requires alterations to their principal residence and or private vehicle to make residents accessible and or the vehicle drivable or rideable.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The resident and or vehicle modification must occur within 365 days after the covered accident. This benefit is payable once per covered accident and up to 1 time per plan year for each covered person.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, I, I
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And so you would just need to send proof.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] Right. Correct. I, I'm not gonna need that. I was just wondering what that means. I'm not, I'm, I refuse to not be able to walk again.
[AGENT][NEUTRAL] Yeah, that's
[AGENT][POSITIVE] Right, exactly. Got you.
[CUSTOMER][NEUTRAL] I just, so, right.
[CUSTOMER][POSITIVE] Hey, thanks, that's, that was helpful. Thank you. Let me, let me grab it, OK.
[AGENT][NEUTRAL] OK. All right.
[CUSTOMER][POSITIVE] Yeah, that's, that's good, that's good. That's all I needed.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that wording is in your policy as well.
[AGENT][NEUTRAL] Under your, it, uh-huh, I'm reading from your, directly from your policy.
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, and it's gonna be, uh, you can find it under section.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] But under additional benefits and it is in section 4.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Of your plan document under the heading additional benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. I will take my time and
[CUSTOMER][MIXED] Even though it's a boring book to read, I will to read through this.
[CUSTOMER][POSITIVE] Uh, thank you. I appreciate that.
[AGENT][POSITIVE] All righty. You're welcome. And then we'll get it.
[CUSTOMER][NEUTRAL] And then what I do with the physical therapy. I'm just going to have the form when you send it and I'll wait how many times they deem that that I need that and then fill it up, send it in at the same time.
[AGENT][NEUTRAL] Yes, well, I mean you could send the bill as it incurs or you could wait till you're finished with your 6 days if you, if it's gonna be that many and send it at the same time, but it's up to you.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, I'm gonna see what they say to me when I get there today.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] All right. Anything else?
[CUSTOMER][POSITIVE] No, you have a wonderful day. Thank you.
[AGENT][POSITIVE] You too, Miss [PII] thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] Mm, goodbye.