AccountId: 011433970860
ContactId: f9b34216-131e-4cf8-b4e6-b2b1736895f3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 691979 ms
Total Talk Time (AGENT): 136198 ms
Total Talk Time (CUSTOMER): 89505 ms
Interruptions: 0
Overall Sentiment: AGENT=2.1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/f9b34216-131e-4cf8-b4e6-b2b1736895f3_20250416T18:47_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon, um, my name is [PII] calling from a provider's office. Uh, we are out of network, probably, uh, we're a chiropractic office. I wasn't sure what button to press on the menu. I just wanted to see if they had benefits.
[AGENT][NEUTRAL] I'm sure, [PII], I can assist you with benefits. Um, first, I'll need a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] Sure, [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you. Now I need the.
[CUSTOMER][NEUTRAL] And that's a direct line.
[AGENT][NEUTRAL] OK. Got it. Thank you. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] Policy.
[CUSTOMER][NEUTRAL] Is
[CUSTOMER][NEUTRAL] 02587090.
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you. And just let me advise you that verification of coverage does not guarantee payment of claims. Um, I'm showing the effective date on this policy was [PII] and the policy is still active. And this is a limited hospital indemnity plan, but we do cover some um outpatient and office visits. Um, and there is no network. We work with our providers. Um, what type of service is this for? What will it take place?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's a chiropractic in our office.
[AGENT][POSITIVE] OK, let's see. That'll be covered under the office visit benefit. In one moment, let me get those benefits for you. They're coming up.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK. According to the information that I've pulled up, I'm only showing coverage for inpatient and outpatient hospital services. And there's only coverage for, let's see, surgery if done in a physician's office. But if you don't mind holding, um, I'll check further to see if this is correct or if there's any updates.
[CUSTOMER][NEUTRAL] Gotcha. I mean, it sounds like it's specifically a hospital card. Um, if you want, do you, does it help you if I provide you a CPT code?
[AGENT][NEUTRAL] Yes, what's the CPT code?
[CUSTOMER][NEUTRAL] You can use 98,940.
[AGENT][NEUTRAL] OK, yeah, that's taking place in the office. One moment, let me place you on a brief hold.
[CUSTOMER][POSITIVE] Sure, yeah, yeah, take your time. Thank you.
[AGENT][POSITIVE] Mhm thank you one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] Transferring.
[CUSTOMER][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Um, hi, [PII]. This is [PII] in the Medli claims department. Um, I have a provider on the line who's calling to verify benefits for a hospital indemnity plan. And could you just take a look right quick and let me know if um it covers chiropractic services. I pulled up the policy and I'm only seeing inpatient and outpatient hospital coverage.
[AGENT][NEUTRAL] I don't see any
[CUSTOMER][NEUTRAL] OK, what's that policy number?
[AGENT][NEUTRAL] Yeah, the policy number is 02587090.
[AGENT][NEUTRAL] For darkness
[CUSTOMER][NEUTRAL] Uh, for Dorcas Samoa.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Um, let's see.
[CUSTOMER][NEGATIVE] Yeah, don't show anything for chiropractic, um, that would not be covered.
[AGENT][NEUTRAL] OK. I didn't think so. I just wanted to make sure. Thank you, ma'am.
[CUSTOMER][POSITIVE] Thank you. Have a good day.
[AGENT][NEUTRAL] You too. Bye.
[AGENT][POSITIVE] OK, [PII], thanks for your patience.
[CUSTOMER][POSITIVE] Yeah, you're welcome, no worries.
[AGENT][NEUTRAL] OK. And actually, um, office visits, including chiropractic visits are not covered under the policy.
[CUSTOMER][NEUTRAL] Got you. OK. And overall there is no out of network benefits for this. This is just a hospital indemnity card you said?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] Got you. OK, sounds good I appreciate your help thank you so much.
[AGENT][POSITIVE] OK, thank you again for calling APL. Have a great rest of your day. Mm bye.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Mm thank you.