AccountId: 011433970860
ContactId: f5f88c98-75bf-4223-8eed-e0a918f2e70a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 460809 ms
Total Talk Time (AGENT): 186680 ms
Total Talk Time (CUSTOMER): 150897 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=1.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/f5f88c98-75bf-4223-8eed-e0a918f2e70a_20250529T21:01_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh, yes, hi, I was calling to see if I can check eligibility and benefits for a mutual patient.
[AGENT][POSITIVE] Sure, I can help you with eligibility and benefits. Can I get your name and a good call back number in case we get disconnected?
[CUSTOMER][POSITIVE] Perfect, yes.
[CUSTOMER][NEUTRAL] Absolutely. So it's [PII], the initial of my last name is [PII], the phone number, the good callback number is [PII].
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][POSITIVE] Thank you so much, [PII], and do you have the policy number with you?
[CUSTOMER][NEUTRAL] I do. The policy number is 60801.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And can I have you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um, yes, it is [PII], and the date of birth is [PII].
[AGENT][NEUTRAL] OK, I think I have a different policy number. Did you say 60801?
[CUSTOMER][NEUTRAL] Yes, that's what um I have written here that they provided.
[AGENT][NEUTRAL] OK, because that's not who.
[CUSTOMER][NEUTRAL] That's not the policy number? OK.
[AGENT][NEUTRAL] I had that's a different policy um let me see because that's our, um, I mean it is a policy number but she probably put our payer ID number on there because that's also our payer ID number.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Oh boy, OK, yes, I think she might have got confused when giving us the because they call us and they give us the details over the phone.
[AGENT][NEUTRAL] OK, um, give me just a moment. Do you have her social? and I can search her by that?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I do, yes, no, unfortunately that I do not have. I can always try and call the patient back to try to get a better policy number.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No, hold on, um, what is her last name?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It's um [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes, no, I'm sorry, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, OK, [PII].
[CUSTOMER][POSITIVE] Yes, sorry, [PII], yes, sorry about that thank you. Thank you, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] No, you're OK we're all in this together.
[AGENT][NEUTRAL] Give me just a moment, um, and what was her first name?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]?
[CUSTOMER][POSITIVE] You got it, yes.
[AGENT][NEUTRAL] Alright, give me just a moment.
[AGENT][NEUTRAL] And I'm so sorry, can you, uh, give me her date of birth one more time?
[CUSTOMER][NEUTRAL] Of course. um [PII].
[AGENT][NEUTRAL] OK, there we go, founder, OK.
[CUSTOMER][POSITIVE] Oh wonderful.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let me go ahead and give you that policy number and let me know when you're ready.
[CUSTOMER][POSITIVE] Uh yes, I'm ready for you.
[AGENT][NEUTRAL] it's 01.
[AGENT][NEUTRAL] 65.
[AGENT][NEUTRAL] 9744.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] OK, and, and I am showing that this is a medlink policy, so it is secondary gap insurance um when filing a claim through this insurance. OK, good, um, I'm showing that this policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] And were there specific benefits you needed me to look at?
[CUSTOMER][NEUTRAL] OK, so I'm looking at um benefits for physical therapy.
[AGENT][NEUTRAL] OK, let me check.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Computer's fighting me today.
[AGENT][NEUTRAL] There we go.
[AGENT][NEUTRAL] Alright, give me just a moment while I go through.
[AGENT][NEUTRAL] The policy and see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and this is just a verification of benefits and not a guarantee of coverage. I'm showing that she has an outpatient benefit maximum of up to $7900 per calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I am showing that under that outpatient benefit, um, she is allotted a physical therapy and a physical therapy facility. It is subject to a maximum of 30 days of treatment per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so she can bill up to 7900?
[CUSTOMER][NEUTRAL] Is that what I'm understanding?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] But she only has 30 visits.
[AGENT][POSITIVE] Correct, 30 days of treatment.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] And that is after her uh primary covers at first they have to show partial benefits being paid, yes.
[CUSTOMER][POSITIVE] Exactly.
[CUSTOMER][NEUTRAL] Being paid. Now she does have, um, so let me ask you, she has a deductible under her um primary plan and the deductible does apply.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, so it's not until she meets the deductible that then they'll cover a certain percentage of the therapy. So you guys would cover whatever the fee is, um, like in, in, in a case where we have a deductible, they pay $100 for the evaluation and $75 for the therapies.
[AGENT][NEUTRAL] So this policy does help with uh co-deductible, co-insurance and copay. So sometimes, uh, so it could go towards the deductible um for that as opposed to all of the procedures, um, it just depends on how much the primary covers.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, this insurance does help pick up the deductible.
[CUSTOMER][POSITIVE] Exactly.
[CUSTOMER][POSITIVE] Excellent. OK, perfect and then can I have um your name and a reference number?
[AGENT][NEUTRAL] So we don't have reference numbers but you can use my name and last initial in today's date, so [PII] and today's date.
[CUSTOMER][NEUTRAL] OK. OK.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Excellent thank you so much, [PII], you were wonderful.
[AGENT][NEUTRAL] Is there anything else I can help you with, [PII]?
[CUSTOMER][NEUTRAL] No, that's everything that I have.
[AGENT][POSITIVE] Right, thank you so much for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you same to you bye bye.
[AGENT][NEUTRAL] Right bye.