AccountId: 011433970860
ContactId: 1867f95e-d54a-401e-9d1e-a78bd2a8a739
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 223669 ms
Total Talk Time (AGENT): 94084 ms
Total Talk Time (CUSTOMER): 119074 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/1867f95e-d54a-401e-9d1e-a78bd2a8a739_20250115T16:36_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hello, I need to look up someone's benefits that wants to come into the office to see if it's gonna be covered for her.
[AGENT][NEUTRAL] Sure, I can assist you with that. Are you calling about medical or dental?
[CUSTOMER][NEUTRAL] Medical
[AGENT][NEUTRAL] Could I have your name and a callback number?
[CUSTOMER][NEUTRAL] My name is [PII] and my callback number is [PII].
[AGENT][NEUTRAL] Thank you. And what's the policy number?
[CUSTOMER][NEUTRAL] So would that be her group number?
[AGENT][NEUTRAL] No, it should say policy or er number.
[CUSTOMER][NEUTRAL] Says payer ID and then it says her name and then it says coverages individual and then it says group number and then it says plan med link select select group in hospital cert number or outpatient number that's all that's on her card.
[AGENT][NEUTRAL] Right, and I requested a policy number or certain number, so the inpatient outpatient certain number would be the policy number.
[CUSTOMER][NEUTRAL] OK, you ready?
[AGENT][NEUTRAL] Yes, I am.
[CUSTOMER][NEUTRAL] 02458533 M like Mary L like Lisa 8.
[AGENT][NEUTRAL] Thank you, [PII]. Could you verify that patient's name and date of birth?
[CUSTOMER][NEUTRAL] Her first name is [PII]. Her last name is [PII], and her birth date is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And you're calling to verify benefits and eligibility for what place of service?
[CUSTOMER][NEUTRAL] For res chiropractic.
[AGENT][NEUTRAL] Inpatient, outpatient office visit?
[CUSTOMER][NEUTRAL] It's so it's an office visit for X-rays and chiropractic treatment.
[AGENT][NEUTRAL] This member's policy has
[AGENT][NEUTRAL] This member's policy has outpatient benefits of $5000 per calendar year, which covers the treatment received in our office. however, the office visit itself is not covered, and this is not a guarantee of benefits, just a disclaimer of the policy's coverage.
[CUSTOMER][NEUTRAL] OK, sorry, can you repeat that? So she has $5000 per year.
[CUSTOMER][NEUTRAL] Of benefits and what were you saying? Sorry.
[AGENT][NEUTRAL] And it only covers the treatment received in the office?
[AGENT][NEUTRAL] And not the office visit itself.
[CUSTOMER][NEUTRAL] Right, so like I, I just never used one of these policies before so I'm not really sure how it works.
[AGENT][NEUTRAL] It's a gap insurance.
[AGENT][NEUTRAL] It assists with the deductible co-pay and co-insurance that the primary put towards that put towards the services.
[CUSTOMER][NEUTRAL] I know, so
[CUSTOMER][NEUTRAL] So do I bill you or does she submit it to you?
[AGENT][NEUTRAL] No, you bill us once you receive the ELB from the primary insurance company because we would need it.
[AGENT][NEUTRAL] To verify what went towards the deductible co-pay and co-insurance.
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Oh, OK, so I understand. So I charge her her co-pay, then when the EOB comes in, I send that over to you and then you reimburse us or her?
[AGENT][NEUTRAL] We reimbur we send the payment to the provider because the provider submitted the claim as long as the assignment of benefits are signed.
[CUSTOMER][NEUTRAL] Right, OK.
[CUSTOMER][NEUTRAL] So it doesn't matter. You don't have to be an authorized provider for this.
[AGENT][NEUTRAL] No, cause this is a gap insurance.
[CUSTOMER][POSITIVE] OK, so I understand how it works. I never dealt with it before, so that's interesting right.
[AGENT][POSITIVE] No worries, that's why we're here for you to call and ask questions.
[CUSTOMER][NEUTRAL] Uh huh alright so I'm glad I took a front and back of her card because I'm gonna need it to submit the claim.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] And I see it says submit claims here OK perfect so I just have to charge her for the office visit, not the treatment.
[AGENT][NEUTRAL] Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] Because you don't cover that.
[AGENT][NEUTRAL] Right, we don't cover that.
[CUSTOMER][POSITIVE] All right perfect I'll let her know thank you.
[AGENT][NEUTRAL] You're welcome. Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][POSITIVE] Um, no, that was it, thanks so much.
[AGENT][POSITIVE] Thanks for calling APL. Have a good day. Goodbye.
[CUSTOMER][NEUTRAL] OK bye. Alright, give me a