AccountId: 011433970860
ContactId: b59b3cd6-e99f-460a-a72c-50582edfcdba
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 542510 ms
Total Talk Time (AGENT): 217405 ms
Total Talk Time (CUSTOMER): 139334 ms
Interruptions: 2
Overall Sentiment: AGENT=0.8, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/b59b3cd6-e99f-460a-a72c-50582edfcdba_20250304T17:32_UTC.wav
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[AGENT][NEUTRAL] Morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Could you please help me checking the benefits for one of our members?
[AGENT][NEUTRAL] I'm sorry, what is your name?
[CUSTOMER][NEUTRAL] This is [PII].
[AGENT][NEUTRAL] OK, [PII], you're needing eligibility and benefits for a member, is that correct? Or just benefits?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Eligibility and benefits.
[AGENT][POSITIVE] Yes, I can help you with that, [PII] and what is your callback number?
[CUSTOMER][NEUTRAL] The callback number is going to be.
[CUSTOMER][NEUTRAL] Uh, here it is. [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number, please?
[CUSTOMER][NEUTRAL] It is uh
[CUSTOMER][NEUTRAL] Uh-huh. Just giving you really quick.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] 02581601.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] And [PII], any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name, please, and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the [PII]'s date of birth is
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. So he is a subscriber on this supplemental policy, and the supplemental policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Give me a second, give, give me a second. Give me a second.
[CUSTOMER][NEUTRAL] Give me a second.
[CUSTOMER][NEUTRAL] [PII]. OK, so you said what's going on with this patient?
[AGENT][NEUTRAL] I said that this supplemental policy is active, effective [PII].
[CUSTOMER][NEUTRAL] Mhm. [PII].
[AGENT][NEUTRAL] And what type?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what type of benefit information do you need for him inpatient, outpatient or office?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, the outpatient visits and, uh, uh, APL is secondary.
[AGENT][POSITIVE] That is correct.
[AGENT][NEUTRAL] And for an office visit?
[CUSTOMER][NEUTRAL] I need to check the
[AGENT][NEUTRAL] I'm sorry, what is your question?
[CUSTOMER][NEUTRAL] I need to check the, I need to check the chiropractic benefits.
[AGENT][NEUTRAL] On this plan, the outpatient benefit max for per calendar year for covered outpatients, uh, actually, let me give me one second.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Chiropractic.
[AGENT][NEUTRAL] Just one moment, [PII]. Did you, can you hear me OK?
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] OK, I had to ask you to hold on for me just a moment, OK? So that I can get the benefit information pulled up.
[AGENT][NEUTRAL] So he has an outpatient benefit maximum of $250 per covered person per calendar day for covered outpatient services because this is a supplemental policy to his primary insurance when the claim is filed with APL Alex, you will also need to send a copy of the primary insurance company's explanation of benefits as well.
[AGENT][NEUTRAL] And then once we have processed our claim, we do have a portal that you can check claim status in and have access to our EOB by going to secured. [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So, you are going to pay $250 each claim?
[AGENT][NEUTRAL] That is the benefit. I'm not guaranteeing payment. As I explained, I can only verify what the benefits are on this policy. We will have to receive the claim for review.
[CUSTOMER][NEUTRAL] So, uh, can you repeat one more time, like $250 as the supplemental.
[AGENT][NEUTRAL] Is the
[AGENT][NEUTRAL] That is the benefit max per calendar day for covered outpatient services.
[CUSTOMER][NEUTRAL] You're going to
[CUSTOMER][NEUTRAL] Benefit max $250.
[CUSTOMER][NEUTRAL] For one visit, right? Or for the multiple visits?
[AGENT][NEUTRAL] No, sir. I said, no, sir, I said per calendar day.
[CUSTOMER][NEUTRAL] Can you fix the claim?
[AGENT][NEUTRAL] Are you asking for our fax number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII] attention claims.
[CUSTOMER][NEUTRAL] Claim fax number.
[AGENT][NEUTRAL] And again, you must also include the primary insurance company's explanation of benefits as well.
[CUSTOMER][NEUTRAL] With claim.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So $250 is benefit max per calendar year.
[AGENT][NEUTRAL] No, no, it's not per that is Alex, no, not per calendar year.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] It is per calendar day.
[CUSTOMER][NEUTRAL] Calendar day
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Means uh each state of service.
[AGENT][NEUTRAL] It is per calendar day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It means each calendar, each visit or what, I, I'm not understanding what does it mean.
[AGENT][NEUTRAL] OK, the benefit is a per calendar day, not a per calendar year. Claims are also processed in the order that they are received.
[AGENT][NEUTRAL] And the benefit maximum on this supplemental policy is $250 per calendar day for covered outpatient services.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] The chiropractor is covered for services, correct?
[AGENT][NEUTRAL] Chiropractic services or something that can be reviewed under this policy for benefits.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] And can be reviewed.
[CUSTOMER][NEUTRAL] All right. Got your point. Give me the call reference number.
[AGENT][NEUTRAL] Again, I'm not guaranteeing payment. Yes, my name and today's date, my name that I gave you along with today's date.
[CUSTOMER][NEUTRAL] Repeat one more time.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And is there anything else, [PII], that I can help you with?
[CUSTOMER][NEUTRAL] It's, it's OK. Thanks for your time. And one more thing, like, is it dependent on this policy?
[AGENT][NEUTRAL] He is the only person he is the subscriber.
[CUSTOMER][NEUTRAL] But uh as per our records and the patient patient that uh uh there is one dependent also in this policy with the name [PII].
[AGENT][NEUTRAL] No, sir.
[CUSTOMER][NEUTRAL] Oh, he can, we can update him.
[AGENT][NEUTRAL] He is the only person covered under this policy.
[CUSTOMER][NEUTRAL] They are dependent on this policy.
[CUSTOMER][NEUTRAL] Can the member update his dependent on the policy or it's not allowed?
[AGENT][NEUTRAL] He would have to contact, no sir, he would have to contact his human resources department that is not something he can do directly with us.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] All right. Thanks for your help. Have a great day.
[AGENT][POSITIVE] Well, you're very welcome. So again, if that's all I can help you with, thank you for calling APL and I hope you have a nice day as well.
[CUSTOMER][NEUTRAL] You too, bye.
[AGENT][POSITIVE] Thank you. Bye-bye.