AccountId: 011433970860
ContactId: 0e47ad7a-353e-4a6c-91f0-3839431cf188
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 672609 ms
Total Talk Time (AGENT): 225571 ms
Total Talk Time (CUSTOMER): 110595 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/0e47ad7a-353e-4a6c-91f0-3839431cf188_20250428T17:46_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 in a provider's office and I have some questions um about a patient's uh insurance benefits.
[AGENT][POSITIVE] OK, well I can definitely help you with the benefits and eligibility. May I have your name and a good contact number?
[CUSTOMER][NEUTRAL] Um, [PII], good phone number is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Um, I have it as D476-838-28.
[AGENT][NEUTRAL] OK, now, do you have a copy of the member's ID card available?
[CUSTOMER][NEUTRAL] I actually do not. I have his driver's license.
[AGENT][NEUTRAL] OK, um, I can look, so basically that the number is for 90 degree benefits, but that's a different company, so we can't use it in our systems. Um, I can search the policy with the first and last name or the full social.
[CUSTOMER][NEUTRAL] Um, can we try his first and last name?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] First name is [PII] sorry, [PII] Last name is [PII], [PII]
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] So I'm just waiting for the policies to populate here. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do you have a middle initial?
[CUSTOMER][NEUTRAL] Uh, [PII] as in it's [PII].
[AGENT][NEUTRAL] Let me see, um.
[AGENT][NEUTRAL] OK, let me try this. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And this is for medical?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] All right, let me look at these medical policies and see if any of them are your patient. Hold on one moment. What's the date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] OK, so so far.
[AGENT][NEUTRAL] Let me try this last one.
[AGENT][NEUTRAL] Here we go.
[AGENT][NEUTRAL] All right. Well, thank you for verifying his information and all the information provided is a verification of benefits, not a guarantee of payment. So the policy number is 253.
[AGENT][NEUTRAL] 763 8.
[AGENT][NEUTRAL] The policy has been effective since [PII].
[AGENT][NEUTRAL] And what type of benefits did you want to go over today?
[CUSTOMER][NEUTRAL] Um, I would like, I'm not sure if we are in network or out of network with this plan. Um, is there a way for you to look that for me?
[AGENT][NEUTRAL] So the policy itself is a hospital indemnity um plan, so there's no network for that part. However, they do have the PPO network through multi-plan. Um, so I can give you either multiplan's phone number or website, we just don't have access to the list of providers because it's a different company.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's OK. Um, I'm looking for his chiropractic and physical therapy benefits.
[AGENT][NEUTRAL] OK, I see. Hold on one moment.
[AGENT][NEUTRAL] And do you mind if I place you on just a brief hold while I look through the benefits?
[CUSTOMER][NEUTRAL] Oh, no, that's OK.
[AGENT][NEUTRAL] Alright, hold on one moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hm.
[AGENT][NEUTRAL] First of all, wait a minute.
[AGENT][NEUTRAL] Let me go see the benefits.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm gonna just, you know what?
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] A decision, yes.
[AGENT][NEUTRAL] All right, thank you so much for holding. I apologize for the wait. So, for the physical therapy, um, benefits that comes out with the physician office benefits and the benefit for this policy is um the policy will pay up to 4 visits at $50 per visit per calendar year. Now, for chiropractor, um, the only way to really guarantee that one is to process the claim because it depends on the coding and how the doctors listed.
[AGENT][NEUTRAL] Since they're not technically a physician. So sometimes it can still be used for that benefit. Um, it just depends on how the paperwork comes in. So that, that would be the only way to guarantee the chiropractor.
[CUSTOMER][NEUTRAL] Can I give you a CPT code?
[AGENT][NEUTRAL] Um, I mean, I, it wouldn't help me out because I'm not a claims examiner and there's no codes on the, um, schedule of benefits. So the best way is to just present it.
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Got you, so it's a $50 co-pay for physical therapy and it's 4 visits.
[AGENT][NEUTRAL] Well, it's not a co-pay, that's what the policy will pay towards the visit.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] She based on.
[CUSTOMER][NEUTRAL] Could I, did you find any chiropractic uh benefits?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Oh you're on the phone.
[CUSTOMER][NEUTRAL] I'm sorry, did you have any chiropractic benefits?
[AGENT][NEUTRAL] There's no benefits specifically for chiropractors. Typically on our policies, they are considered with the physician office, which is why I'm saying it it depends on what we see when it comes in, because the chiropractor is not technically a physician, but sometimes those benefits are used, so we are not examiners, we can't determine that, but when you process the claim, it will be determined.
[CUSTOMER][NEUTRAL] Is there a visit uh limit for that?
[AGENT][NEUTRAL] Yes, it's 4 visits per calendar year at $50.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's also the same benefit for the.
[CUSTOMER][NEUTRAL] And then [PII], can I have a reference number?
[AGENT][NEUTRAL] Sure, so there's no call reference.
[CUSTOMER][NEUTRAL] It'd be the same.
[AGENT][NEUTRAL] For for physical therapy.
[AGENT][POSITIVE] Physical therapy definitely uses that benefit. The chiropractor could, depending on the paperwork.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But if it's the same day, it's gonna be one or the other because it's per day, up to 4.
[CUSTOMER][POSITIVE] OK perfect thank you.
[AGENT][NEUTRAL] You're welcome, and there's no call um reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Wonderful thank you so much [PII] appreciate your help.
[AGENT][POSITIVE] Oh, I'm so sorry if you hear them doing the yard work.
[CUSTOMER][POSITIVE] Oh, you're fine. You have a great rest of your day.
[AGENT][POSITIVE] They just came by the window. You too. Thanks for calling APL. Bye-bye.
[CUSTOMER][NEUTRAL] Bye-bye.