AccountId: 011433970860
ContactId: f64268ff-62e1-4c92-988b-543b50dd7696
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 288079 ms
Total Talk Time (AGENT): 146998 ms
Total Talk Time (CUSTOMER): 151055 ms
Interruptions: 9
Overall Sentiment: AGENT=0.9, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/06/f64268ff-62e1-4c92-988b-543b50dd7696_20250606T18:07_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, so, um, my name is [PII]. I'm calling here from South Miami Walkin Orthopedic. I'm just calling to see if, um if you guys go ahead and like cover the, um, the co-payments and, um, for a patient.
[AGENT][NEUTRAL] OK, sure, I can assist you with benefits on co-payment coverage, um, and may I have a callback number just in case we get disconnected, Miss [PII]?
[CUSTOMER][NEUTRAL] Yeah it's [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. May I have the patient's policy number?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I don't because there's two of them. I don't know if it's I'm assuming it's the outpatient um benefit it's uh 0163.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 7396 ML 8.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient, Ms. [PII]?
[CUSTOMER][NEUTRAL] Yeah, uh, [PII] [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK. And it will be for, OK, so for a specialist office visit or is it for physical therapy?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Hi [PII], uh, my name is [PII]. I'm calling from.
[CUSTOMER][NEUTRAL] Uh, for, well, it'll be for a specialist office and then um to see if it covers X-rays and ultrasounds, uh, physical therapy, and DME.
[AGENT][NEUTRAL] OK. Before I give you any benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer.
[CUSTOMER][NEUTRAL] Oh yeah, for, um, OK, so no problem, I'm gonna go ahead and, uh.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And let's see, I'm waiting on the paperwork, bear with me.
[CUSTOMER][NEUTRAL] Mhm I can schedule another day.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] OK, so this is one of our secondary supplemental plans to the major medical.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The effective date of [PII] and is still active.
[AGENT][NEUTRAL] And for the outpatient benefits, OK, let's see.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] No problem
[CUSTOMER][NEUTRAL] You're all set
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] OK. So for the outpatient benefits for the office setting, for an office setting, we do cover the office procedures. Now, we do not cover the office visits. So office visits are not covered, only office procedures. Um, now, if it's a physical therapy and you charged as a physical therapy facility, then we do cover the um co-payment for the physical therapy, but we do not cover for regular um office visit, OK?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So like if um sorry I have a question um because our we have a physical therapy in our office but it's completely separate from the doctor's side is that covered or no?
[AGENT][NEUTRAL] This is subject to fine.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] If they charge us for physical therapy as a physical therapy facility, then the co-payment is covered for the physical therapy.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Yes. Now, if it's just a regular office visit, then that one is not covered. The regular office visit is not covered. We do cover only the procedures done in the office, OK? And this is subject to the outpatient maximum which is 1000 per covered person per calendar day.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect. OK, um, the X-rays and ultrasounds, um, that's not covered or it is?
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm, yeah, those are the procedures. Procedures done in office are covered. Mhm mhm.
[CUSTOMER][POSITIVE] OK, OK, perfect.
[CUSTOMER][NEUTRAL] Sorry, sorry about that and then the medical dual equipment you said no, right?
[AGENT][NEUTRAL] Yes OK
[AGENT][NEUTRAL] Uh, no, I don't think that one has a coverage. Let me double check. Oh yeah, they do. They do have doable medical equipment benefits. So yeah, that's gonna be part of the outpatient maximum.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK perfect and that one's covered as well. OK, perfect, perfect, thank you so much I appreciate it. Can I have a reference number for this call?
[AGENT][NEUTRAL] Mhm, yes.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will. Do you need the spelling of my name or any other information, Miss [PII]?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] You said your name was [PII], OK.
[AGENT][NEUTRAL] Yes, uh-huh, that's correct. Last initial [PII]
[CUSTOMER][POSITIVE] And OK perfect thank you so much I appreciate it.
[AGENT][NEUTRAL] Mhm
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good day, Miss [PII].
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you, bye-bye.