AccountId: 011433970860
ContactId: bc9d47b3-e89a-40e0-bfd1-1125e7cff4c5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 353059 ms
Total Talk Time (AGENT): 137629 ms
Total Talk Time (CUSTOMER): 103894 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/25/bc9d47b3-e89a-40e0-bfd1-1125e7cff4c5_20250325T16:37_UTC.wav
--------------------------------------------
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] from Allied Chiropractic, and I'm calling to see if you could help me um get benefits for a patient.
[AGENT][POSITIVE] Yeah, I'm happy to check on benefits today for you, [PII]. Do you have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] That is 02.
[CUSTOMER][NEUTRAL] 58
[CUSTOMER][NEUTRAL] 6172.
[AGENT][NEUTRAL] All right. And do you have a good callback number just in case if we're disconnected?
[CUSTOMER][NEUTRAL] Yes, that's going to be [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And then can I get the patient name and date of birth?
[CUSTOMER][NEUTRAL] Um, first name is [PII] and then last name [PII]
[CUSTOMER][NEUTRAL] Date of birth [PII].
[AGENT][POSITIVE] Thank you so much. So the patient is active. The effective date on the plan is [PII].
[CUSTOMER][NEUTRAL] Excuse me, and I am looking to see if I can get um acupuncture and chiropractic benefits.
[AGENT][NEUTRAL] OK, let's take a look here.
[AGENT][NEUTRAL] Right, so this is a verification of benefits, not guarantee of payment. The patient does have a limited benefit hospital indemnity plan. So this plan is going to pay a set amount depending upon what the patient's being seen for. They're allowed up to 4 office visits with a physician in a calendar year, and the benefit payment towards that is $100.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And that's for the office you said.
[AGENT][NEUTRAL] Mhm. Correct, yeah.
[AGENT][NEUTRAL] The only other thing I see on the plan is just PT for like physical therapy, but I don't think that would apply to like acupuncture.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] So office visits, um, I guess does it is it a set CBT code?
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEGATIVE] Cause I
[CUSTOMER][NEUTRAL] Because an an office visit for us is like in the evaluation or an examination.
[AGENT][NEUTRAL] It looks
[AGENT][NEUTRAL] It's like an, OK.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] So yeah, it looks like, so under the plan, it just has outpatient accident sickness treatment. So it breaks it down for a physician's office visit $100 per day, maximum of 4 days. And then it has a benefit for any sort of physical, speech, occupational therapy, $60 a day.
[AGENT][NEUTRAL] Everything else is really hospital admission and intensive care on the plan.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] And then, so this, this kind of plan or insurance is not is something that we've never seen in our office, um, are you, I guess, are you able to tell me if we're um.
[CUSTOMER][NEUTRAL] Like uh in network provider for this plan?
[CUSTOMER][NEUTRAL] Or is that something
[AGENT][NEGATIVE] So yeah, this plan doesn't require any sort of network for usage. It's not like a PPO or anything like that. It's not, it's not major medical. It's a limited benefit plan. So it's only gonna pay that $100 towards an office visit, regardless of what they're coming in for. It's not gonna pay anything over that.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and then on the card I see a [PII].
[CUSTOMER][NEUTRAL] Um, I.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh, yeah, yeah, [PII].
[CUSTOMER][NEUTRAL] [PII] sorry um is that where we're sending claims?
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] Yes ma'am, uh huh.
[CUSTOMER][POSITIVE] OK, OK, perfect.
[CUSTOMER][POSITIVE] OK perfect I think that is all I need.
[AGENT][POSITIVE] OK, sounds good. Thank you for calling AP. Have a good day. Bye.
[CUSTOMER][POSITIVE] Perfect thank you
[CUSTOMER][POSITIVE] Thank you have a you too bye bye.
[AGENT][NEUTRAL] Bye.