AccountId: 011433970860
ContactId: aa1c2fbf-69f6-4bc2-a220-8aec4261bddf
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 327010 ms
Total Talk Time (AGENT): 97904 ms
Total Talk Time (CUSTOMER): 194786 ms
Interruptions: 4
Overall Sentiment: AGENT=0.6, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/aa1c2fbf-69f6-4bc2-a220-8aec4261bddf_20250204T15:36_UTC.wav
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[AGENT][POSITIVE] Thank you for calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, your name is [PII]. How you doing, [PII]? My name is [PII], and I'm calling you from Barangwin Healthcare Center, and I have an EOP in front of me, but I would like to know if the patient is responsible for the balance that we sent over to you guys. It's a co-payment from the primary.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Good, how are you?
[AGENT][NEUTRAL] OK, let me take.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I can take a look at that for you, [PII]. Could I get a callback number?
[CUSTOMER][NEUTRAL] Mhm, [PII].
[CUSTOMER][NEUTRAL] Extension [PII].
[AGENT][NEUTRAL] Thank you. And what is the policy number you're calling on?
[CUSTOMER][NEUTRAL] OK, 02064066.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] It is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you so much for verifying the policy and uh you did say you were calling to check to see if there's patient responsibility on a service. What is the data service?
[CUSTOMER][NEUTRAL] For this insurance.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 12 5 2024.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] So app run 0 charges.
[AGENT][NEUTRAL] And total bill 351.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so it looks like for this data service, um, the policy allows for office visits per calendar year. It shows that they had maxed out their benefits, um, by the time we received the claim, um, so benefits were not paid. Now we do not determine patient responsibility, that would be up to the provider.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So then.
[CUSTOMER][NEUTRAL] Mm, OK.
[AGENT][NEUTRAL] But the claim was denied because they had exhausted this benefit for the calendar year.
[CUSTOMER][NEUTRAL] If I look
[CUSTOMER][NEUTRAL] OK, how about.
[CUSTOMER][NEUTRAL] I have 3 claims, wait, let me see if the primary has picked up on them.
[CUSTOMER][NEUTRAL] I don't think yet. Let me see, so for the, the new year [PII], it starts over again? It's only 4 visits? OK.
[AGENT][POSITIVE] Yes, it does.
[AGENT][NEUTRAL] Mhm, for a calendar year.
[CUSTOMER][NEUTRAL] 4 per.
[CUSTOMER][NEUTRAL] Year.
[CUSTOMER][NEUTRAL] OK, for [PII], um.
[AGENT][NEUTRAL] Did you want to check a claim for [PII]?
[CUSTOMER][NEUTRAL] I'm looking to see if the insurance has acknowledged it. Give me a second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I don't think so.
[CUSTOMER][NEUTRAL] Come on computer.
[CUSTOMER][NEUTRAL] I keep clicking on it if I leave it alone, it moves.
[CUSTOMER][NEGATIVE] Oh my god, OK, uh, no.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] No, no, no, I'm gonna have to wait until they process their claims. OK, so it's 4 per year for, um, for medical visits. How about chiropractor is considered medical visit, am I right?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 4 per year, yes ma'am.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me take a look at the policy benefits.
[CUSTOMER][NEUTRAL] Run run the report again and don't.
[AGENT][NEUTRAL] OK, so it looks like for this policy, please be advised verifying benefits does not guarantee payment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Um, they do not have a chiropractor benefits for this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Give me one more second because I I wanna see what type of visit this patient had.
[CUSTOMER][NEUTRAL] Come on.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Come on.
[CUSTOMER][NEUTRAL] That's the charge and the adjust.
[CUSTOMER][NEGATIVE] Just like stay stuck on me.
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] Am I really stuck?
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Chiropractic and Harry Archer, which is a primary care doctor.
[CUSTOMER][NEUTRAL] OK, yeah, chiropractic and so far it's chiropractic and Harry Archer.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And let me see.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, a reference number please?
[AGENT][NEUTRAL] Yes, to reference our call, you will use my name, [PII]
[AGENT][NEUTRAL] And today's date.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome. Thank you for calling APL you have a wonderful day.
[CUSTOMER][POSITIVE] OK bye thanks bye.
[AGENT][NEUTRAL] Bye bye.