AccountId: 011433970860
ContactId: 1b1673fc-c61e-43e9-a063-83b45be1ffc2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 264279 ms
Total Talk Time (AGENT): 148894 ms
Total Talk Time (CUSTOMER): 86501 ms
Interruptions: 2
Overall Sentiment: AGENT=1, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/03/1b1673fc-c61e-43e9-a063-83b45be1ffc2_20250103T16:06_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] and I'm calling from a chiropractic office, and we are treating a mutual patient, uh, for chiropractic care, and I wanted to get, um, get chiropractic benefits. This patient has UnitedHealthcare as primary.
[AGENT][NEUTRAL] OK, [PII], you're needing to get benefit information for chiropractic care. Is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Yes, ma'am. I can help you. And what is your callback number?
[CUSTOMER][NEUTRAL] [PII] no extension.
[AGENT][NEUTRAL] Thank you and the member's policy number, please?
[CUSTOMER][NEUTRAL] Policy number I have 02212366M as in Mary L as in Lima number 8.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And any information [PII] that I provide for you today will be a verification of benefits and not a guarantee of payment. What is the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Sure, the first name of the patient is [PII], uh last name [PII] Uh date of birth I have is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So on the supplemental policy, I do show that she is a subscriber.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And is this being done in a, in an office?
[CUSTOMER][NEUTRAL] In a specialist office correct.
[AGENT][NEUTRAL] OK. So on her policy, she does have an office treatment writer. Now, the visit itself is not a covered benefit under the supplemental policy, the charge for the visit, but again, she does have the treatment rider, which we can review the treatment. The outpatient benefit maximum on this plan is $7150 per covered person per calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] For covered outpatient services.
[AGENT][NEUTRAL] And there is no outpatient deductible per covered person.
[AGENT][NEUTRAL] per calendar.
[CUSTOMER][NEUTRAL] Got you. Now, by the sounds of it, will this plan cover the primary, um, the United Healthcare, which is the primary, um, their copay, it says the copay of $30 so will you guys cover that co-pay then?
[AGENT][NEUTRAL] Again, I cannot guarantee payment of benefits. I can only, I can only, I cannot guarantee payment. I can only provide you the benefit information. And under this supplemental policy, it is designed to help with their co-pays, deductibles, and co-insurance amounts of covered services. Now, office visit charges are not covered under this supplemental policy. We can review the treatments, right, we can, right.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Got you. No, this would just be for adjustments. This would just be for adjustment, yeah, that's fine.
[AGENT][NEUTRAL] But we will have to receive the claim along with also a copy of a primary insurance company's explanation of benefits for review.
[AGENT][NEUTRAL] And then [PII], we do have a portal that once the claim has been processed through APL you can check claim status and also have access to the explanation of benefits by going to [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Got it thank you so much and you said your first name was [PII], correct?
[AGENT][NEUTRAL] Yes, and you would use my name along with today's date as your call reference number.
[CUSTOMER][NEUTRAL] I was like
[CUSTOMER][POSITIVE] Perfect, that is all that I need. Thank you so much, [PII], and happy weekend.
[AGENT][POSITIVE] OK, well, you, um, happy weekend to you as well, [PII], and thank you again for calling ATL if that's all I can help you with.
[CUSTOMER][POSITIVE] Thank you take care bye bye.
[AGENT][NEUTRAL] You too. Bye-bye.