AccountId: 011433970860
ContactId: ee9f0088-83cf-4f47-b2d1-8a8191fcb932
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 183360 ms
Total Talk Time (AGENT): 74782 ms
Total Talk Time (CUSTOMER): 63795 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/ee9f0088-83cf-4f47-b2d1-8a8191fcb932_20250521T19:20_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 Coconut Grove Chiropractic. Um, just wanted to verify if you guys, um, cover chiropractic services for a member.
[AGENT][POSITIVE] OK. Happy to check on uh benefits. Do you have your policy number?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Wait, uh huh, policy number.
[CUSTOMER][NEUTRAL] Um, I have a group number and a plan, but I don't see.
[CUSTOMER][NEUTRAL] It says oh outpatient benefit certification number maybe?
[AGENT][NEUTRAL] Do
[AGENT][NEUTRAL] Yeah, a certain, yeah, a certain number. There you go.
[CUSTOMER][NEUTRAL] OK, OK, um, so I think I have to, I'll give you one of them it's 025.
[CUSTOMER][NEUTRAL] 69537.
[CUSTOMER][NEUTRAL] ML 8.
[AGENT][NEUTRAL] All right. And then let me get the patient name and date of birth, please.
[CUSTOMER][NEUTRAL] So, it would be [PII], and date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. So, patient is active. It looks like the effective date on here is [PII].
[AGENT][NEUTRAL] And we are the secondary insurance, so it does cover deductible, co-pay, co-insurance that the primary does not.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, looks like this patient's plan does have an outpatient benefit max. Let me check that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, it's a calendar day, so it's $750.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's not gonna cover the physician office visit fee if there is one. I will cover any sort of treatment or services by a physician though.
[CUSTOMER][NEUTRAL] Oh, wait, what do you mean by that?
[AGENT][NEUTRAL] So it would, if they have like a co-pay with their primary insurance for the visit, like the fee, it's not gonna cover that um it's only gonna cover any sort of treatment administered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Mhm, OK.
[CUSTOMER][NEUTRAL] Hold on.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, but they do cover.
[AGENT][NEUTRAL] Did you me check on anything else?
[CUSTOMER][NEUTRAL] No, that's all, that's all, that's all.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] You're welcome. Have a good day.