AccountId: 011433970860
ContactId: c3f9f212-9385-479e-a851-910e84f66229
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 410989 ms
Total Talk Time (AGENT): 162408 ms
Total Talk Time (CUSTOMER): 144575 ms
Interruptions: 1
Overall Sentiment: AGENT=0.1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/13/c3f9f212-9385-479e-a851-910e84f66229_20250113T18:53_UTC.wav
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[AGENT][NEUTRAL] For calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I'm calling to get chiropractic benefits on a patient.
[AGENT][NEUTRAL] OK, I can help you. What's your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And the policy number, [PII]?
[CUSTOMER][NEUTRAL] Um, well, I don't have the policy number. I, I have one that was for um the 90 degrees.
[AGENT][NEUTRAL] With the D number?
[CUSTOMER][NEUTRAL] Um, but they told me I needed to talk to you.
[AGENT][NEUTRAL] OK, do you have the social of the cardholder?
[CUSTOMER][NEUTRAL] I do not. I just have her name and date of birth.
[AGENT][NEUTRAL] OK, spell the first and last name.
[CUSTOMER][NEUTRAL] Uh first name is [PII] Last name is [PII]
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and what's a good phone number, [PII], uh, [PII], in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] [PII] thank you.
[AGENT][NEUTRAL] Uh, the spelling of the last name is [PII] What came after the [PII]?
[CUSTOMER][NEUTRAL] [PII], yeah.
[AGENT][NEUTRAL] [PII]. Uh-huh.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Yep.
[AGENT][NEUTRAL] And verify the date of birth of the patient.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And you said that you're checking, uh, you know, chiro benefits. OK.
[CUSTOMER][NEUTRAL] Chiropractic benefits.
[AGENT][NEUTRAL] OK. The policy number for American Public Life is 250.
[AGENT][NEUTRAL] 2185.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK, and is there a group number?
[AGENT][NEUTRAL] Uh-huh, one moment, let me get you the benefit and then I'll move to the group number and name.
[CUSTOMER][POSITIVE] Oh sure, no problem.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] All right, so I'm showing an effective date of [PII].
[CUSTOMER][NEUTRAL] And um I don't, I'm not really sure, but is this a multi-plan policy?
[AGENT][NEUTRAL] It's a limited, um, hospital indemnity plan.
[CUSTOMER][NEUTRAL] Oh, OK, because we're, I mean, we're not hospital at all. It's doctor's office. So is there benefits for doctor's office?
[AGENT][NEUTRAL] That's just the name of the policy. It may have an office visit benefit.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And and multiplan would be the PPO network of contracted providers.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK, we're not in multiplan.
[AGENT][NEUTRAL] Yeah, that's fine.
[CUSTOMER][NEGATIVE] So be out of network.
[AGENT][NEUTRAL] See, I'm showing the policy is currently active.
[AGENT][NEUTRAL] And the maximum office visit benefit is up to $75 per visit.
[AGENT][NEUTRAL] And then there's a max of 5 visits per calendar year.
[AGENT][NEUTRAL] Of course, the information provided is verification only and for [PII], is this for manipulation or?
[CUSTOMER][NEUTRAL] Manipulation office visit, X-rays, physical therapy.
[AGENT][NEUTRAL] Yeah, so physical therapy has to be done by a physical therapist, so that would not be covered. The x-rays would not be covered and the doctor's fee will not be covered.
[CUSTOMER][NEUTRAL] And yeah.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] The manipulations you mean?
[AGENT][NEUTRAL] Did you say there was an office visit fee?
[CUSTOMER][NEUTRAL] Well, I mean, we, we do, it would be manipulations. I mean, we'd build different codes. It wouldn't just be an office visit code, yeah, it would be manipulations, physical therapy, office visits, X-rays. You said X-rays are not covered.
[AGENT][NEUTRAL] A 99 series.
[AGENT][NEUTRAL] I know.
[AGENT][NEUTRAL] I know, so I was asking.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEGATIVE] If it's an office visit fee, the 99 series code that's not covered.
[AGENT][NEUTRAL] Physical therapy is not
[CUSTOMER][NEUTRAL] The what code?
[AGENT][NEUTRAL] You said it's an office visit fee, the 99213 or whatever the code is for the [PII] office.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEGATIVE] That is not covered.
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] And then physical therapy is not.
[CUSTOMER][NEUTRAL] Wait a minute, but you said the office, they, they cover up to 75% of the office visit.
[AGENT][NEUTRAL] But I'm trying to tell you what's covered under that benefit. Perhaps the only thing we could consider is the manipulation. Any other charges are not covered.
[CUSTOMER][NEUTRAL] Or 75 $75.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] Because we're out of network.
[AGENT][NEUTRAL] Because it's not covered by the policy, and physical therapy has to be performed by a physical therapist.
[CUSTOMER][NEGATIVE] OK, I, I got that the PT is not covered. I got that. And the X-ray is not covered. The manipulation, you said is or isn't? I'm, I'm confused.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] We can consider that benefit. I can't guarantee it. We'll have to receive the claim first.
[CUSTOMER][NEUTRAL] OK, well, that's kind of
[CUSTOMER][NEUTRAL] Weird. OK, so you're not sure about the manipulation.
[AGENT][NEUTRAL] We just have to look at the coding.
[AGENT][NEUTRAL] We have to look at the CPT coding on the coin.
[CUSTOMER][NEUTRAL] You're not sure about the manipulation and the office, you said the office visit is not covered.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] So, um, what do you cover?
[AGENT][NEUTRAL] It's because of the type of service of Cairo is not a licensed MD.
[AGENT][NEUTRAL] So office visits are covered for MDOs.
[CUSTOMER][NEUTRAL] But they are licensed to order X-rays and do physical therapy and do an office visit and the manipulations.
[AGENT][NEUTRAL] But, but they're not credentialed as an MD, so that's why it's not covered.
[CUSTOMER][NEUTRAL] OK, so I'm just, I'm just gonna tell the patient that she doesn't have coverage here because this is um no all right do you have a reference number for this call?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] You'll use my name in today's date, [PII]st initial last name is R as in Randy Kristen. Any other questions?
[CUSTOMER][POSITIVE] Uh, nope, that'll do it. Thank you very much.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] All right, bye bye.
[CUSTOMER][NEUTRAL] You too