AccountId: 011433970860
ContactId: 56ae2827-23f0-4f40-bd8c-12e530cdef93
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 473440 ms
Total Talk Time (AGENT): 214850 ms
Total Talk Time (CUSTOMER): 136511 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/56ae2827-23f0-4f40-bd8c-12e530cdef93_20250227T18:02_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi there, I'm calling from Complete Health Center in [PII], trying to find out uh eligibility for a new patient of ours.
[AGENT][NEUTRAL] OK, sure. I can assist you with the eligibility. And may I have your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And Ms. [PII], may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure it's [PII].
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Uh, I have her ID number is D as in dog 43222881.
[AGENT][NEUTRAL] Um, we cannot pull with that. Um, that's just for IMA. Do you see anything that says policy certificate? It starts with a 0 followed by 7 digits.
[CUSTOMER][NEUTRAL] Uh, no, she just gave me the information on the phone. Can you pull it up by birth date at all?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] OK, um, I can do a name search. May I have the spelling of the last name?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Your first name?
[CUSTOMER][NEUTRAL] Is [PII].
[AGENT][NEUTRAL] And what's her date of birth?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, um, bear with me, let me see if I can find it.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Let me try your first name again.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] There, there's an apostrophe between the [PII] and the K, so I don't know if that matters, but she said it was [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, um.
[AGENT][NEUTRAL] Uh, let me try that again. So [PII] and then [PII]
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] No, I'm not taking it. Um, let me see if I can leave a space. Maybe, maybe we didn't have a way of putting the apostrophe, so let me just do a space and try it like that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] No, no, I can pull up. Do you have her social?
[CUSTOMER][NEUTRAL] I do not.
[AGENT][NEUTRAL] OK, let me try one more time, um.
[AGENT][NEUTRAL] What
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Do you know her address?
[CUSTOMER][NEUTRAL] Yes, it is [PII], and the zip code is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] I think I found her um.
[AGENT][NEUTRAL] [PII]. Yes, that's her. OK, and let's see you said you need eligibility.
[CUSTOMER][NEUTRAL] Yeah, eligibility and benefits for chiropractic and then um so when we submit this, would we submit it under the policy number and not the ID?
[AGENT][NEUTRAL] Uh.
[AGENT][NEUTRAL] Um, let me check where it goes first, OK? One moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, this one goes to IMA before it comes to us. They do their repricing through multi plan if you participate with it, and they do any payments for preventative before it's sent to us. So since it's going to IMA, you can use that the number.
[CUSTOMER][NEUTRAL] You can use the ID number?
[AGENT][NEUTRAL] Yes, mhm.
[CUSTOMER][NEUTRAL] OK, OK, perfect and then um for chiropractic, is there any specifics?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me check on that. And before I give you any benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer. And let's see, we have an effective date of
[AGENT][NEUTRAL] [PII], it is active. Now, this is one of our limited hospital indemnity plan.
[AGENT][NEUTRAL] Um, so it is a limited plan. Let me look at the benefits and see if there's anything for chiropractor.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And this is gonna be like for manipulation or?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. All right.
[AGENT][NEUTRAL] Mm.
[AGENT][POSITIVE] Gonna be one more minute. I'm waiting on the benefits to pull up. Thank you for your patience.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] OK, so if it's for manipulation is usually covered under the physician's office benefit, and this is not a guarantee of payment, just a verification of coverage. We cover $50 per day, maximum of 4 days per covered person per calendar year, and that is an indemnity amount which is a flat amount.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So $50 co-pay and 4 visits per year.
[AGENT][NEUTRAL] It's $50 payment, so the amount we cover is $50. They don't have a co-payment, co-insurance or deductible because this is a limited policy.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So they don't, they just pay whatever the balance is.
[AGENT][NEUTRAL] After the 50, correct.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, and you said it's limited to 4 visits per calendar year?
[AGENT][POSITIVE] Correct, and this is combined benefits, combined visits.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] 4 visits or 9 visits?
[AGENT][NEUTRAL] 4
[CUSTOMER][NEUTRAL] 4, OK, sorry, so you said 9. OK, and then um.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, is it, it's so it's a limited plan, so it's not really a deductible or anything they just pay only a certain amount.
[AGENT][NEUTRAL] Correct. Uh, this one is an indemnity policy, which it pays an indemnity amount of $50 per day.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Alright and then um is there any reference number for the call?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you will. Do you need the spelling of my name or any other information?
[CUSTOMER][NEUTRAL] Sure, yeah.
[AGENT][NEUTRAL] OK. My name is [PII]. That's [PII]. Last initial [PII].
[CUSTOMER][POSITIVE] OK alright I appreciate it thank you.
[AGENT][POSITIVE] You're welcome and thank you for calling APO. Have a good day, [PII].
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.