AccountId: 011433970860
ContactId: f0a02f11-62df-4f8a-a124-501d01648afd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 396929 ms
Total Talk Time (AGENT): 157988 ms
Total Talk Time (CUSTOMER): 93592 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/f0a02f11-62df-4f8a-a124-501d01648afd_20250520T17:14_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm calling from a provider's office. My first name is [PII]. I need to verify um benefits or the policy for a patient.
[AGENT][NEUTRAL] I can help you with verification. Um, can I get a good callback number in case we get disconnected, [PII]?
[CUSTOMER][NEUTRAL] It's [PII] and that's a direct line.
[AGENT][NEUTRAL] OK. And do you have the policy number with you?
[CUSTOMER][NEUTRAL] Yeah, yeah, um, she told us it's 02138628.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, let me look that up real quick.
[AGENT][NEUTRAL] And what's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, [PII], I'm not sure if it's pronounced [PII] or [PII], and then [PII].
[AGENT][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, give me just a moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] It looks like this policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And is there, was there something specific?
[CUSTOMER][NEUTRAL] Well, she has a primary policy through Blue Cross. Do you guys just pick up like the excess basically or?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, I'm looking for physical therapy benefits specifically if that helps you out, and we are outpatient office.
[AGENT][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] Yes, because we are secondary insurance, so the major medical, um, we typically ask for them to be to go first, and then we ask for the EOB when submitting the claim, showing if benefits were paid.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, let me pull up her policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this is a hospital indemnity policy, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let me look up
[AGENT][NEUTRAL] Physical therapy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just a moment.
[AGENT][POSITIVE] I'm so sorry. Did you say outpatient?
[CUSTOMER][NEUTRAL] Yeah, we are an outpatient provider.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right, and this is a verification of benefits and not necessarily a guarantee of payment. I am showing that she does have
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Outpatient sickness, accident and sickness treatment benefits, um, for physical therapy at a physical therapy facility, she is allotted up to $60 per day with a maximum of 1 day per calendar year.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] She has a hospital admission.
[CUSTOMER][NEUTRAL] OK, so did I hear you right? I'm not.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] Sorry, go ahead.
[CUSTOMER][NEUTRAL] She gets one day of outpatient physical therapy. Did I hear you right?
[AGENT][NEUTRAL] Yes, I'm seeing physical.
[AGENT][NEUTRAL] Outpatient accident and sickness treatment benefit at a physical, speech, or occupational therapy facility, $60 per day with a maximum of 1 day per calendar year.
[AGENT][NEUTRAL] However, let me see if she has anything other than that.
[AGENT][NEUTRAL] I'm showing a rehabilitation benefit of up to $200 per day, a maximum of 5 days per calendar year per covered person.
[AGENT][NEUTRAL] But if I look at just physical therapy, I'm only seeing specifically, I'm only seeing that one.
[CUSTOMER][NEUTRAL] OK, that's all right. I just wanted to make sure that she didn't have anything through this, um, her primary policy, she's almost met her out of pockets and stuff, so we shouldn't shouldn't be an issue either way, um, perfect, um, just in case, um, we pre-verify before they come in for their appointment, do you guys have a claims address?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] We do have a claims address. So, um.
[CUSTOMER][NEUTRAL] Or the, OK.
[AGENT][NEUTRAL] So the address for claims will be [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] In [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK perfect all right thank you um do you give a reference number or is it?
[AGENT][POSITIVE] Great. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Oh, I think that's probably all.
[AGENT][NEUTRAL] OK, um, we don't do reference numbers, but we do, um, you can use my name and first and last initial, so [PII], and today's date.
[CUSTOMER][POSITIVE] OK perfect thank you so much for your time have a great day.
[AGENT][POSITIVE] Great. Thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] Uh-huh, OK.
[AGENT][NEUTRAL] Bye.