AccountId: 011433970860
ContactId: f4af46a5-e5b2-4a1d-bf03-bb0ed660f5c8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 313890 ms
Total Talk Time (AGENT): 122110 ms
Total Talk Time (CUSTOMER): 126460 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/f4af46a5-e5b2-4a1d-bf03-bb0ed660f5c8_20250404T14:34_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, um, good morning. um I'm actually a provider and I'm calling for physical therapy benefits.
[AGENT][NEUTRAL] Can I have your name and a callback number?
[CUSTOMER][NEUTRAL] Yeah, that will be [PII], my last initial callback number is [PII].
[AGENT][NEUTRAL] Thank you, ma'am. What is the policy number of the member that you're calling to verify physical therapy benefits for?
[CUSTOMER][NEUTRAL] Yeah, I have number 01887294 M for Mary, L for Lima, the number 8.
[AGENT][NEUTRAL] How many 8s are there in the number?
[CUSTOMER][NEUTRAL] 3.
[AGENT][NEUTRAL] So give me that number again because it's not pulling up a policy.
[CUSTOMER][NEUTRAL] Yeah, sure. Um 01887294, the letter M for Mary, L for Lima, and the number 8.
[AGENT][NEUTRAL] So there's only 2 8s in the in the number.
[CUSTOMER][NEUTRAL] Um, yes, for the first.
[CUSTOMER][NEUTRAL] Numbers like for the first four digits, but there is the number 8 as the last number.
[AGENT][NEUTRAL] What is the member's name and date of birth?
[CUSTOMER][NEUTRAL] [PII]. Date of birth [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] This policy has been active since [PII]. It's currently active. You're calling to verify [PII] has physical therapy benefits?
[CUSTOMER][POSITIVE] Yeah, physical therapy benefits in an office setting.
[AGENT][NEUTRAL] He has outpatient benefits of $4000.
[AGENT][NEUTRAL] It has outpatient benefits of $4000 per calendar year and this is not a guaranteed benefit just a disclaimer of the policies policies coverage. So would the physical therapy be performed by a physical therapist?
[CUSTOMER][NEUTRAL] Um, yes, but the place of service is office.
[CUSTOMER][NEUTRAL] By specialist. Yeah.
[AGENT][NEUTRAL] Oh, he does not have office visits?
[AGENT][NEUTRAL] Coverage, however, he does have the treatment received in the office coverage which falls under his outpatient benefits. Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] Oh, you said that's the only benefit this patient have, right? The 4000. Is that the, what do you call?
[AGENT][NEUTRAL] Yes, $4000 per calendar year for outpatient services and the treatment received in the office falls under the outpatient benefits.
[CUSTOMER][NEUTRAL] So you don't have like what you call co-pay, coinsurance.
[AGENT][NEUTRAL] No, this is a gap insurance. He has a primary insurance.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] And no deductible, no out of pocket, and is there a visit limitation?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] So that will be based on medical necessity.
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] And are you requiring authorization or referral?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, and is this plan runs in the calendar year?
[AGENT][NEUTRAL] Yes, from January to December.
[CUSTOMER][NEUTRAL] OK, and what's your timely filing for claims and the claims mailing address?
[AGENT][NEGATIVE] There's no timely filing.
[CUSTOMER][NEUTRAL] OK, and the claims mailing address?
[AGENT][NEUTRAL] It'll be addressed to American Public Life Claims Department.
[CUSTOMER][NEUTRAL] That.
[AGENT][NEUTRAL] [PII]. That's [PII]. [PII]. That's [PII]. Is there anything else that I can assist you with today, ma?
[CUSTOMER][NEUTRAL] Hey, question for you, um, can claims be faxed to you guys and what would be the fax number?
[AGENT][NEUTRAL] have a fax number is [PII]. That's [PII]. Attention claims department.
[CUSTOMER][POSITIVE] OK, thank you so much. Your name and reference number please?
[AGENT][NEUTRAL] My name is [PII]. And today's date is a reference mail because unfortunately we don't provide reference numbers.
[CUSTOMER][NEUTRAL] That's OK. I'm sorry, by the way, for the out of 4000, um, is there accumulation with that?
[CUSTOMER][NEUTRAL] Currently?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] He has used $437.52 of his benefits.
[CUSTOMER][POSITIVE] 437 52. OK. Thank you so much.
[AGENT][POSITIVE] Yes, that is correct.
[AGENT][POSITIVE] You're welcome thanks for calling APL have a great day.
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Bye.