AccountId: 011433970860
ContactId: e7ffeaec-0df6-4208-ac72-8cbece7adb04
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 279459 ms
Total Talk Time (AGENT): 115697 ms
Total Talk Time (CUSTOMER): 70822 ms
Interruptions: 0
Overall Sentiment: AGENT=1.9, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/03/e7ffeaec-0df6-4208-ac72-8cbece7adb04_20250603T13:02_UTC.wav
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[AGENT][POSITIVE] And thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Yes, I'm calling to get benefits for our patient.
[AGENT][POSITIVE] Um, yes, ma'am. I can assist you with benefits. Um, first, could I get your name and a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII]. My phone number is [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII]. Now, could I get the policy number, please?
[CUSTOMER][NEUTRAL] Yes, it's D as in dog.
[CUSTOMER][NEUTRAL] 43302314
[AGENT][NEUTRAL] OK, that's not one of our policy numbers. Um, do you have the member social? I can look them up that way.
[CUSTOMER][NEUTRAL] Uh, I have a policy slash cert number. Is that what you're looking for?
[AGENT][NEUTRAL] OK, that
[AGENT][NEUTRAL] Yes, ma'am. That sounds like the correct number. What's that number?
[CUSTOMER][NEUTRAL] OK, it's 02584640.
[AGENT][NEUTRAL] OK. Please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yes, it's [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you, [PII], and yes, that's his policy number and just let me advise you the verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII] and the policy is still active. And what type of service is this for?
[CUSTOMER][NEUTRAL] Chiropractic.
[AGENT][NEUTRAL] OK. And it will take place in my office?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, one moment. His benefits are coming up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK, and I'm still waiting on my system. Thanks for your patience.
[CUSTOMER][POSITIVE] No problem.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK. Yes, ma'am. For all office visits, including chiropractic, we cover up to $75 per visit and he gets 5 visits per calendar year.
[CUSTOMER][NEUTRAL] 5
[CUSTOMER][NEUTRAL] Um, what is your allowable for an adjustment?
[AGENT][NEUTRAL] Um, well, this is a limited.
[CUSTOMER][NEUTRAL] I've never worked with your company before.
[AGENT][NEUTRAL] Yes, ma'am. This is a limited hospital indemnity plan, but we do cover some outpatient um services. And so, um, yeah, we go by the maximum benefit.
[AGENT][NEUTRAL] Amount and for office visits, um, the benefit is is based on a daily basis. And so, like I said, we cover up to $75 per visit and he gets 5 visits per calendar year. And I can let you know how many visits he's used so far.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, all 5 visits are available. He hasn't used any of his uh benefits yet this year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And then um to send the claims is the electronic payer ID 64556, is that correct?
[AGENT][POSITIVE] Yes, ma'am. That's correct.
[CUSTOMER][NEUTRAL] OK, there was just so many numbers on the card. I was like, OK, I better double check that.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] All right. I think that answers all my questions.
[AGENT][POSITIVE] OK. Well, since there isn't anything else I can assist you with, [PII], um, I thank you for calling APL and you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too. Bye-bye.
[AGENT][POSITIVE] Mhm. Thank you. Mm bye.