AccountId: 011433970860
ContactId: 4f3e5755-b5ee-45e3-ba46-2f853cdb4aa1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 370899 ms
Total Talk Time (AGENT): 121569 ms
Total Talk Time (CUSTOMER): 114491 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/20/4f3e5755-b5ee-45e3-ba46-2f853cdb4aa1_20250220T22:11_UTC.wav
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[AGENT][POSITIVE] Thank you for calling Tory. How may I help you?
[CUSTOMER][NEUTRAL] Uh, the phone cut out just a little bit. What did you say?
[AGENT][NEUTRAL] This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII] and I'm just trying to get um.
[CUSTOMER][NEUTRAL] Eligibility and benefits for a patient.
[AGENT][NEUTRAL] OK, [PII], I can help with eligibility and benefits. Can I please get your call back number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And then what's the name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] [PII], date of birth [PII] policy number 02566531.
[AGENT][NEUTRAL] OK, let me pull up that policy real quick.
[AGENT][NEUTRAL] I do show that [PII] does have an active policy with us and active date is [PII].
[AGENT][NEUTRAL] And this verified benefits, it's not a guarantee of payment. This is a supplemental insurance policy, uh, the gap insurance that helps with deductible and co-insurance.
[AGENT][NEUTRAL] And he had an inpatient benefit amount of $3000.
[AGENT][NEUTRAL] And let's see.
[AGENT][NEUTRAL] He also has an outpatient benefit amount of $3000.
[CUSTOMER][NEUTRAL] OK, so you guys pay up to 3000?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] For deductible copay or coinsurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I have called on one before. OK, so this would be for chiropractic benefits and for the one.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] We uh had used before for a different patient. It said that the office visit co-pay was not covered, um, but treatment can be considered. Is that gonna be the same with this policy or is that gonna be?
[AGENT][NEUTRAL] Let me check. He may have a different policy, so let me pull up his policy and see what it says.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's gonna be just a moment while it loads.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And I didn't catch your name because it's still cutting out a little bit.
[AGENT][NEUTRAL] I'm sorry, can you repeat what you just said? My phone has been acting.
[CUSTOMER][NEUTRAL] Yeah, it's cutting out. Uh, what did you say your name was?
[AGENT][NEUTRAL] Oh,
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][NEGATIVE] It's still cut out.
[AGENT][NEUTRAL] Oh no, it's [PII].
[CUSTOMER][NEUTRAL] Got you, OK.
[AGENT][NEUTRAL] OK good. Alright, let me look at his office visits and see.
[AGENT][NEUTRAL] Yes, this is the same thing. He does not have a.
[AGENT][NEUTRAL] Let's see, it excludes physician office visit fee.
[CUSTOMER][NEUTRAL] OK, so office visit co-pays are not covered.
[AGENT][NEUTRAL] Office visits are.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] Um, but the manipulation is different.
[AGENT][POSITIVE] Correct, yes ma'am.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, and we just.
[CUSTOMER][NEUTRAL] Submit it to you after we get get it back from Blue Cross.
[AGENT][NEUTRAL] Right after the primary pays their part is submitted with the EOB from the primary.
[CUSTOMER][NEUTRAL] OK, and is there a timely filing requirement?
[AGENT][NEUTRAL] No ma'am, we don't have one.
[CUSTOMER][NEUTRAL] You said there's not one.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] And no referral or anything like that required.
[CUSTOMER][NEUTRAL] Since it's secondary.
[AGENT][NEUTRAL] No, because we're not the primary, correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, hang on just one second, let me find that phone.
[CUSTOMER][NEUTRAL] More of a real chiropractic with Suzie.
[CUSTOMER][NEUTRAL] Hey
[CUSTOMER][NEUTRAL] Momentarily, can you give me just a second? I'm finishing up on the other line.
[CUSTOMER][NEUTRAL] OK, um, so sorry about that, uh, that should be all I need from you other than a reference number.
[AGENT][NEUTRAL] That's
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes ma'am, you can use my name [PII] and today's date.
[CUSTOMER][POSITIVE] [PII]. OK, thank you so much.
[AGENT][POSITIVE] You're welcome, miss you have a good day and thanks for calling APL.
[CUSTOMER][NEUTRAL] You too mm bye.
[AGENT][NEUTRAL] Bye bye.