AccountId: 011433970860
ContactId: 00870eda-367d-4e2a-a158-86165a4d6bf7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 385519 ms
Total Talk Time (AGENT): 138548 ms
Total Talk Time (CUSTOMER): 75127 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/00870eda-367d-4e2a-a158-86165a4d6bf7_20250213T19:48_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I'm a provider and I'm calling to check a patient's chiropractic benefits.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the chiropractic benefits, and may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Absolutely it's [PII], it's spelled [PII] The telephone number is [PII], no extension.
[AGENT][NEUTRAL] Thank you for that. And [PII], may I have the member's policy number?
[CUSTOMER][NEUTRAL] 60801.
[AGENT][NEUTRAL] Um, so that's our payer ID, um, on the card. Do you see anywhere that says in hospitals or outpatient policy certification number?
[CUSTOMER][NEUTRAL] Um, he just gave it to me over the phone. Is it 162-57?
[AGENT][NEUTRAL] Oh, OK.
[AGENT][NEUTRAL] Um, that may be their group number, but I can probably get to them from there. Hold on one moment.
[CUSTOMER][NEUTRAL] I'm sorry, I always ask, but there's always so many numbers on the card and like getting it from aged people aren't always the easiest.
[AGENT][NEUTRAL] It's OK.
[AGENT][NEUTRAL] Isn't easy, right, it's OK. Um, can you, um, I'm sorry, what is the member's first and last name?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And it's [PII] Date of birth [PII].
[AGENT][POSITIVE] Thank you for that and hold on one moment.
[AGENT][NEUTRAL] And can you verify his date of birth for me, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And so, um, I am showing the policy is active, it's been effective since [PII]. And do you mind if I place you on just a brief hold to look for the chiropractic um coverage?
[CUSTOMER][POSITIVE] Oh that would be perfect thank you.
[AGENT][NEUTRAL] You're welcome. Hold on one moment.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Because it doesn't say.
[AGENT][NEGATIVE] The thing is the chiropractor isn't. Oh God.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Well they said specialist is included in the OTR though and chiropractor is included under, oh, answer.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Hi, yes.
[AGENT][NEUTRAL] Thank you so much for holding. I apologize for that wait. So again, just for the call, all the information provided is a verification of benefits, not a guarantee of payment. So under outpatient, the policy would pay um
[AGENT][POSITIVE] Up to 5, I'm sorry, that's impatient, sorry.
[CUSTOMER][POSITIVE] No, that's OK take your time.
[AGENT][NEUTRAL] I'm scrolling and I thought it went to outpatient and oh, it's the same. OK. So it's $5000 per covered person per calendar year.
[AGENT][NEUTRAL] Now, the policy itself does not have like any in-office coverage, um, in-office setting coverage, but they do have the office treatment rider. So any treatment that's done in the physician or specialist office as long as it's not cosmetic, could be covered up to that $5000 per calendar year.
[CUSTOMER][NEUTRAL] OK, now it doesn't show that um his United Healthcare is primary, so do the claims automatically get um cross billed to APL?
[AGENT][NEUTRAL] No, once, um, once United Healthcare gives the explanation of benefits, then you would file a claim with us and attach that explanation of benefits and your um itemized bill in the form.
[CUSTOMER][POSITIVE] OK, that makes sense, yeah, we have a couple of patients that we have to pay bill OK and uh thank you so much for your help. I do appreciate it.
[AGENT][POSITIVE] You're very welcome. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] No that was it thank you so much.
[AGENT][POSITIVE] Alright, well, thanks for calling APO. You're welcome. Have a great day, [PII].
[CUSTOMER][POSITIVE] You too bye thank you.
[AGENT][NEUTRAL] Bye bye.