AccountId: 011433970860
ContactId: efd64030-15cd-4f35-b70e-20c93db24b8a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 233820 ms
Total Talk Time (AGENT): 116410 ms
Total Talk Time (CUSTOMER): 102687 ms
Interruptions: 3
Overall Sentiment: AGENT=2.3, CUSTOMER=2.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/efd64030-15cd-4f35-b70e-20c93db24b8a_20250131T21:34_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], I'm calling to confirm this patient, they have a secondary coverage that covers physical therapy for our facility, outpatient hospital.
[AGENT][POSITIVE] OK, yeah, I'd love to double check coverage for you today. Do you mind if I have your name and a good callback number?
[CUSTOMER][NEUTRAL] Sure, my name is [PII]. Callback number is [PII].
[AGENT][POSITIVE] Perfect. And Ms. [PII], can I have that policy number?
[CUSTOMER][NEUTRAL] Yes, it
[CUSTOMER][NEUTRAL] 016652.
[CUSTOMER][NEUTRAL] 23 M like Mike L like Larry and the number 8.
[AGENT][POSITIVE] Thank you and give me a moment to get that pulled up for you.
[CUSTOMER][NEUTRAL] Well, sure.
[AGENT][NEUTRAL] All right, Ms. [PII], thanks for your patience. If you could verify your member's first and last name and date of birth.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] Alright, perfect. I do see Ms. [PII] right here. She's current and active with an effective date of
[AGENT][NEUTRAL] It looks like
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]. OK, and does she have any outpatient hospital benefits for the year? Has she used any of them? She does? Mhm.
[AGENT][NEUTRAL] OK, yeah. Let me take a look at her calendar year benefits and her usage so far. Um, while I'm pulling those up, I do want to let you know that any benefit information given over the phone is always just a verification of coverage and not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK mhm.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] It looks like her outpatient benefit with us is going to be $400 per calendar day.
[CUSTOMER][NEUTRAL] 100 per calendar day. OK, perfect. And then do you guys have any restrictions to physical therapy coverage? Do you cover that? Because I know sometimes they don't.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] Let me check her policy document real quick.
[CUSTOMER][POSITIVE] OK. Thank you. Thank you, [PII]. Yeah.
[AGENT][POSITIVE] It's an excellent question.
[AGENT][POSITIVE] Absolutely.
[AGENT][NEUTRAL] All right.
[AGENT][POSITIVE] You're having a great day so far?
[CUSTOMER][POSITIVE] Oh, so far so good. We're almost there, past the finish, past the halfway mark, so.
[AGENT][NEUTRAL] I know.
[AGENT][NEGATIVE] It, it's like we're on a downhill road right now. Yes.
[CUSTOMER][POSITIVE] Definitely getting better. Right, right.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] All right, and I'm so close to her.
[CUSTOMER][POSITIVE] Well, I leave at [PII], so I still have some time, a good 2 hours.
[AGENT][NEUTRAL] Oh, OK. I'm like 2 hours away, so.
[CUSTOMER][NEUTRAL] Oh, OK, yeah, we'll be there in no time.
[AGENT][POSITIVE] No time at all, and you don't have to work over the weekend, right?
[CUSTOMER][NEUTRAL] Oh no, thank God, next 2 days of rest.
[AGENT][POSITIVE] Good. OK.
[AGENT][NEUTRAL] And then I do see here she has under her outpatient benefits um listed um physical therapy facility uh for places of treatment. So, yes, she does have that.
[CUSTOMER][POSITIVE] Definitely.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So she can't use the $400 per calendar day each time she comes in for the, for the treatment, I mean for the therapy basically.
[AGENT][NEUTRAL] Um, yeah, absolutely. You'll just wanna make sure you, when you submit the claim to us that you send the major medical EOB with it.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, and then the PO box for the claims, is it the [PII]?
[AGENT][NEUTRAL] You betcha. Mhm.
[CUSTOMER][POSITIVE] Perfect. Alright, thank you so much for your time and your help, [PII]. Is there a call reference number and the first initial of your last name we can use for the reference number?
[AGENT][NEUTRAL] Yes, there is. Um, the first initial to my last name is B like boy, and then the reference number is my name, [PII] and today's date.
[CUSTOMER][POSITIVE] Perfect. Alright, thank you so much for your time. You were very helpful. I hope you enjoy the rest of your day and have a great weekend.
[AGENT][POSITIVE] Hey you too, Ms. [PII], thanks for calling APL and you take care.
[CUSTOMER][POSITIVE] No problem. You too. Bye.
[AGENT][NEUTRAL] Bye-bye.