AccountId: 011433970860
ContactId: d0fea7da-cbb5-4a02-a765-946936736a6b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 382149 ms
Total Talk Time (AGENT): 151146 ms
Total Talk Time (CUSTOMER): 131572 ms
Interruptions: 1
Overall Sentiment: AGENT=0.3, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/d0fea7da-cbb5-4a02-a765-946936736a6b_20250123T15:11_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I was calling to verify chiropractic benefits for a patient.
[AGENT][NEUTRAL] OK, and your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] And the policy number, [PII]?
[CUSTOMER][NEUTRAL] It is um 02560304.
[AGENT][NEUTRAL] And what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And what's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] It is [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK. Give me one moment, OK?
[CUSTOMER][NEUTRAL] Of course.
[AGENT][NEUTRAL] Let me pull up the file.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And I'm still on the phone verifying um so we'll just let you know if what it's gonna be.
[CUSTOMER][NEUTRAL] Did you want the schedule?
[CUSTOMER][NEUTRAL] OK your time.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] The [PII] work for you?
[CUSTOMER][POSITIVE] Awesome. You're all set.
[AGENT][POSITIVE] Thank you, [PII], for holding.
[CUSTOMER][NEUTRAL] Oh, of course.
[AGENT][NEUTRAL] And give me the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yeah, it's [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, so I'm showing an effective date of [PII].
[AGENT][NEUTRAL] And I show the policy is active at this time.
[AGENT][NEUTRAL] And you said for chiropractic benefit?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And what uh type service will be done today or during the visit?
[CUSTOMER][NEUTRAL] Uh, we're not sure yet. She hasn't been seen. We were just calling for like general coverage.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, so, you know, a chiropractor is not considered an MD, uh, so manipulation is a form of treatment. Um, there is a treatment writer under this policy. Um, physical therapy wouldn't be covered because it has to be performed by a licensed PT, but there is a treatment writer perhaps for manipulation, um, under the outpatient benefit. Would you like that?
[CUSTOMER][NEUTRAL] Yes, we don't do any PC here we just do manipulation.
[AGENT][NEUTRAL] OK. OK. So I'm showing that treatment uh benefit under outpatient is up to $3500. That is per calendar year.
[AGENT][NEUTRAL] And the information provided today is verification, not a guarantee of payment, and let me see if any of that has been used for [PII].
[AGENT][NEUTRAL] Yep, do not, do not show any claims on file for [PII] at this time. And any other questions, [PII] I can help with today?
[CUSTOMER][NEUTRAL] Yeah, so sorry, we've just never seen this plan before, so the 3500 you said that's like the max that the supplement will pay so basically it covers 100% until the patient's deductible is met on their.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Primary major medical or?
[AGENT][NEUTRAL] So this is a a gap a met gap policy, which is secondary to the major medical and it does assist with covered charges applied towards the deductible, co-insurance and or co-pay amounts up to the policy benefit maximum. So outpatient, it's not specific to chiropractic service. It's any outpatient service. So that maximum of up to 3500 is for any covered outpatient service.
[CUSTOMER][NEUTRAL] OK. Um.
[AGENT][NEUTRAL] And this policy acts as a secondary payer.
[AGENT][NEUTRAL] To the major medical plan.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Perfect. So would we collect from the patient then, like the Aetna allowables if she has Aetna primary, would we collect those or since they pay up to the 3500, we wouldn't collect from the patient.
[AGENT][NEUTRAL] OK, so because there's an outpatient benefit for treatment in the office up to 3500 under her secondary plan, I, you know, you submit the claim to the primary and then the secondary first.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Because they do have a benefit under this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect then I guess we're just gonna.
[AGENT][NEUTRAL] I mean, I can't
[AGENT][NEUTRAL] Yeah, I can't tell you to, to.
[CUSTOMER][NEUTRAL] Submit and see how it comes back because.
[AGENT][NEUTRAL] Yeah, right. I can't tell you to, to.
[CUSTOMER][NEUTRAL] I just don't know what the patient responsibility would be.
[AGENT][NEUTRAL] And nor do we until it's processed by the major Medical unless you call them to get their benefit.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][POSITIVE] Yeah, so we have her primary benefits.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] And that she has that 3500 deductible that they have to meet like before her primary starts covering anything. So is that what the supplement does is they cover that deductible for her.
[AGENT][NEUTRAL] Yes, up to 3500. Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect perfect perfect all right then I think we're on the same page. Thank you so much for your help. Do you give out reference numbers?
[AGENT][NEUTRAL] OK. All right.
[AGENT][NEUTRAL] You'll use my name in today's date as your reference. [PII].
[AGENT][NEUTRAL] Oh [PII] and first initial last name is [PII]. Any other questions?
[CUSTOMER][POSITIVE] Awesome. No, that was it. Thank you so much.
[AGENT][POSITIVE] Alrighty, thanks for calling APL have a good day.
[CUSTOMER][NEUTRAL] You too bye.