AccountId: 011433970860
ContactId: f8d05177-10ac-4c35-9bf5-8bd85f89bc8f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 482829 ms
Total Talk Time (AGENT): 181907 ms
Total Talk Time (CUSTOMER): 133944 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/29/f8d05177-10ac-4c35-9bf5-8bd85f89bc8f_20250129T21:33_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][POSITIVE] Hi, yeah, I'm actually calling for physical therapy benefits. Can you help me with this?
[AGENT][NEUTRAL] Uh, yes, I can help you with physical therapy benefits and can you please repeat your name for me?
[CUSTOMER][NEUTRAL] Yeah, my name is [PII] and then [PII], my last initial.
[AGENT][NEUTRAL] OK, thank you [PII] and then what is your callback number please?
[CUSTOMER][NEUTRAL] That will be [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And then what is the patient's name?
[CUSTOMER][NEUTRAL] This, uh, this is for [PII].
[CUSTOMER][NEUTRAL] And his date of birth is [PII].
[AGENT][NEUTRAL] Thank you and what is uh [PII]'s policy number?
[CUSTOMER][NEUTRAL] That will be 02332588.
[CUSTOMER][NEUTRAL] And M for Mary, L for Lima, and the number 8.
[AGENT][NEUTRAL] OK, thank you and what's the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] South Florida, physical therapy and sports rehab.
[AGENT][NEUTRAL] OK, I'm gonna put you on um.
[AGENT][NEUTRAL] Just a little time out while I pull up that policy for us.
[CUSTOMER][NEUTRAL] Yeah, sure.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I do show that [PII] does have an active policy and his effective date is
[AGENT][NEUTRAL] For [PII].
[AGENT][NEUTRAL] I'll need to pull in his policy to make sure that he has physical therapy benefits.
[CUSTOMER][NEUTRAL] OK, and by the way, um.
[AGENT][NEUTRAL] And it'll be just a moment while.
[CUSTOMER][NEUTRAL] Thank you. Sorry. By the way, I actually needing uh physical therapy benefits performed by a specialist in an office setting.
[AGENT][NEUTRAL] OK. Physical therapy in office setting. OK.
[CUSTOMER][NEUTRAL] Specialist, yeah.
[AGENT][NEUTRAL] Now this policy, and this is just to verify right, this policy just is.
[AGENT][NEUTRAL] Just to verify his coverage, it's not a guarantee of payment. This is a supplemental insurance policy that is a gap insurance that helps with deductible, co-pay and co-insurance.
[AGENT][NEUTRAL] He does have an outpatient benefit amount of $2000 per calendar year to go towards the deductible co-pay or co-insurance.
[AGENT][NEUTRAL] I'm looking now to see about.
[AGENT][NEUTRAL] His physical therapy benefits. Let me check.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so he does have physical therapy benefits of
[AGENT][NEUTRAL] And this is what it states an office center or clinic in which a licensed physical therapist provides physical therapy benefits.
[AGENT][NEUTRAL] Physician cover charges for necessary treatment services and supplies recommended by a physician incurred in a physician's office.
[AGENT][NEUTRAL] So he does have physical therapy.
[AGENT][NEUTRAL] Benefits
[AGENT][NEUTRAL] That can be used towards the deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, is there anything else I can help you with, male?
[CUSTOMER][NEUTRAL] Oh sorry, just to confirm, uh, for that's the same as a specialist visit, right?
[AGENT][NEUTRAL] It's, it's done by facility.
[CUSTOMER][NEUTRAL] OK. Yeah.
[AGENT][POSITIVE] And he does have physical therapy benefits that can be used for his outpatient.
[CUSTOMER][NEUTRAL] I see. So,
[CUSTOMER][POSITIVE] Thank you and do you have like a specific if there is.
[CUSTOMER][NEUTRAL] You said that that's 2000 per calendar year, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and is there already been used for that out of 2000?
[AGENT][NEUTRAL] Let me
[AGENT][NEUTRAL] Let me look and see if he's used anything this year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] He has used $85 this year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And this is not like subject to, you know, co-pay or coinsurance, right?
[AGENT][NEUTRAL] No.
[AGENT][POSITIVE] This is, um, this, yeah, this actually helps with those with the deductible co-pay or coinsurance.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sorry, sorry, you said 85?
[AGENT][NEUTRAL] Yes, he's used $85.
[CUSTOMER][NEUTRAL] OK, thank you. And do you have like a visit limitation?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, and are you requiring authorization or referral?
[AGENT][NEUTRAL] No, because this is not a medical major insurance.
[CUSTOMER][NEUTRAL] OK, and you said the this plan starts at [PII], and is there a termination date?
[AGENT][NEUTRAL] No, the policy is active.
[CUSTOMER][NEUTRAL] OK, timely filing for claims and the claims mailing address if you have.
[AGENT][NEUTRAL] There's not a timely filing limit and the claims address is [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] That's in [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Let me
[CUSTOMER][NEUTRAL] Sorry, let me check, um, you said [PII].
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] I mean [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh yeah, [PII]. What's the um zip code again?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, thank you, this will be it and may I have your name and reference number?
[AGENT][NEUTRAL] Yes, you can use my name. It's [PII] and today's date.
[CUSTOMER][POSITIVE] OK, thank you so much. um bye bye.
[AGENT][POSITIVE] You're very welcome. You have a good day and thanks for calling APL.
[CUSTOMER][POSITIVE] Thank you bye bye.