AccountId: 011433970860
ContactId: bbd069fc-28e4-4579-bf58-b30164e86c43
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 474109 ms
Total Talk Time (AGENT): 168375 ms
Total Talk Time (CUSTOMER): 135676 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/bbd069fc-28e4-4579-bf58-b30164e86c43_20250424T21:18_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], I'm calling from Doctor [PII]'s dinner, um, office. I'm trying to
[CUSTOMER][NEUTRAL] I'm see I'm trying to figure out the eligibility of one of our patients who wants to come in.
[AGENT][NEUTRAL] OK, I can help you with eligibility. I'm sorry, I missed your name. What was that?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK, [PII].
[AGENT][NEUTRAL] Do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Um, she only gave us a group number.
[AGENT][NEUTRAL] OK, um, let me get that pulled up. Hold on one moment.
[AGENT][NEUTRAL] What's that group number?
[CUSTOMER][NEUTRAL] It's 19698.
[AGENT][NEUTRAL] And do you have his name?
[CUSTOMER][NEUTRAL] It's his spouse, um, it's a [PII].
[AGENT][NEUTRAL] Do you know the uh the insured's name?
[CUSTOMER][NEUTRAL] The insured, no, I'm not sure of her husband's name.
[AGENT][NEUTRAL] And is this for like medical services or?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] And so the last name is, what was the last name?
[CUSTOMER][NEUTRAL] Um, [PII], the first name is [PII] and the last, well, her name is [PII].
[AGENT][NEUTRAL] OK um let me see.
[CUSTOMER][NEUTRAL] Uh, she, um, the plan, the plan is Medin select group.
[AGENT][NEUTRAL] Yeah, I've got, I've got, uh, I don't have anybody with that last name under this group, so I'm trying to figure out which one might be.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] Um, let me see.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Is she in the office or no?
[CUSTOMER][NEUTRAL] No, I was just checking, I was just checking eligibility, um.
[CUSTOMER][NEUTRAL] Until she gets here for her appointment.
[CUSTOMER][NEUTRAL] But she did say she is OK, OK, here we go, the insured is um I don't wanna butcher the name.
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][NEUTRAL] OK, that was the one I tried.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] It looks like they have different last names.
[CUSTOMER][NEUTRAL] And the and the the last name is [PII].
[AGENT][NEUTRAL] OK. Um.
[AGENT][NEUTRAL] OK, so it looks like.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Looks like the policy is going to terminate for her on 5125, but I can definitely give you benefits right now.
[CUSTOMER][NEUTRAL] 5125.
[AGENT][NEUTRAL] Is she coming in before that?
[CUSTOMER][NEUTRAL] Yes, she will be coming in before.
[AGENT][NEUTRAL] OK, let's, uh, let me get it pulled up.
[AGENT][NEUTRAL] Did you have her date of birth?
[CUSTOMER][NEUTRAL] 1 2nd.
[CUSTOMER][NEUTRAL] Her date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Uh, show the policies effective [PII] or [PII].
[AGENT][NEUTRAL] Um, it's got a
[AGENT][NEUTRAL] Term date of [PII], um, but, and then let me pull up what the benefits are. This is not a guarantee of payment, it's a basic outline of the policy.
[AGENT][NEUTRAL] That pulled up.
[AGENT][NEUTRAL] Is this gonna be for outpatient services or what type of services?
[CUSTOMER][NEUTRAL] Chiropractic services.
[AGENT][NEUTRAL] So this policy has a $7500 calendar year maximum payout.
[AGENT][NEUTRAL] And it is a secondary policy, so it's gonna process after primary insurance has processed the claim to potentially pick up any deductible, co-pay or co-insurance.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Um, so, um, does, does, does our practice have to be in, um, network or no?
[AGENT][NEUTRAL] No, it doesn't. Um, there's no network, and then it will pay for procedures and treatments rendered in the office, just not an actual office visit. So, if you do bill an actual office visit, that charge will be denied, but any treatments or procedures that are rendered in the doctor's office, those will be covered under that benefit of 7500.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] So, for example, um, if she does have a co-pay of let's say uh $30 or $25 would you guys be able to, to cover that?
[AGENT][NEUTRAL] Yes, if that's like for an adjustment or something.
[AGENT][NEUTRAL] Is that what you're saying?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, it would be eligible for reimbursement. Yes.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] As long as primary has considered the claim.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] They do have to consider the claim, so they, if it's denied under her primary, we would deny it as well.
[CUSTOMER][NEUTRAL] OK, OK dokes, um, OK, um, could I have the address that we mail claims to?
[AGENT][NEUTRAL] Yes, address is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 1 2nd, 2
[AGENT][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And it's [PII].
[AGENT][NEUTRAL] And zip code is [PII].
[CUSTOMER][NEUTRAL] Um, could you please repeat the zip code is [PII]?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, and your name is? I didn't get your name.
[AGENT][NEUTRAL] Uh, my name is [PII]. First initial to last name is [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] And do I get a reference number, [PII]?
[AGENT][NEUTRAL] Uh, you can just use my name and then today's date as a reference.
[CUSTOMER][POSITIVE] OK, OK, OK, thank you so much, my darling, you have been a great help.
[AGENT][POSITIVE] OK, thank you for calling APL. Have a great evening.
[CUSTOMER][NEUTRAL] You as well bye bye.
[AGENT][NEUTRAL] All right, bye.