AccountId: 011433970860
ContactId: 051d56b3-6599-4779-84da-8bc438109ecb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 745130 ms
Total Talk Time (AGENT): 240629 ms
Total Talk Time (CUSTOMER): 241391 ms
Interruptions: 3
Overall Sentiment: AGENT=1.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/051d56b3-6599-4779-84da-8bc438109ecb_20250416T15:15_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey [PII] how are you?
[AGENT][POSITIVE] I'm doing well how are you doing this morning?
[CUSTOMER][NEUTRAL] I'm doing fine. I'm calling um because I have a patient here with insurance and I'm trying to get her um insurance either faxed or get the breakdown.
[AGENT][NEUTRAL] OK, um, I can help you uh with the benefits for the patient. And can I please get your name and your callback number just in case the call is disconnected?
[CUSTOMER][NEUTRAL] Um, [PII] [PII] option two.
[AGENT][NEUTRAL] OK, and Ms. [PII], what is the um name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Aspen Dental
[AGENT][NEUTRAL] And the patient's name, date of birth, and policy number.
[CUSTOMER][NEUTRAL] Um, [PII] [PII] policy number is 626-066-32.
[AGENT][NEUTRAL] OK, let me look up that insured real quick.
[AGENT][NEUTRAL] OK, can you give me that policy number one more time, please?
[CUSTOMER][NEUTRAL] 626-066-32
[AGENT][POSITIVE] OK. Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I'm not able to pull up that policy number 626-06632.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you see another number there?
[CUSTOMER][NEUTRAL] Uh, what about member ID?
[AGENT][NEUTRAL] Let's try that one.
[CUSTOMER][NEUTRAL] It's let me see 345 it's 500, so 00002606632.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, let me try that one real quick.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, I think I have her.
[AGENT][POSITIVE] That was a good dumper. OK. Uh, [PII] does have an active policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And that number was um was that a member ID number?
[AGENT][NEUTRAL] Yes, that's all. Her policy number is 260.
[AGENT][NEUTRAL] 663 2.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And her effective date? Uh yes, ma'am.
[CUSTOMER][NEUTRAL] And what is her group number?
[AGENT][NEUTRAL] Her group number is 70084.
[CUSTOMER][NEUTRAL] 70084.
[CUSTOMER][NEUTRAL] OK, and her group name?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Surge, S U R G E, staffing.
[CUSTOMER][NEUTRAL] OK, and her effective date?
[AGENT][NEUTRAL] [PII]. And if you can give me your fax number, I'll send a fax back to you with her benefit breakdown and fee schedule.
[CUSTOMER][NEUTRAL] OK, it's [PII].
[CUSTOMER][NEUTRAL] 423.
[CUSTOMER][NEUTRAL] 0228.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold while I get that fax ready for you, Ms. [PII], and I will be right back.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me, Ms. [PII]. I have
[AGENT][NEUTRAL] That fax on its way to you now.
[CUSTOMER][NEUTRAL] Hello? OK.
[AGENT][POSITIVE] Yes ma'am, I have the fax on its way to you now.
[CUSTOMER][NEUTRAL] OK, um, and another question, um.
[CUSTOMER][NEUTRAL] OK, and do you have the claim um address?
[AGENT][NEUTRAL] Yes ma'am, that would be [PII].
[AGENT][NEUTRAL] 248.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 950.
[AGENT][NEUTRAL] And that's in [PII], [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK, you said [PII]?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK and uh.
[CUSTOMER][NEUTRAL] Let me see, I just have like 3 more 4 more questions. OK, do you know, um, do you accept assignments of benefits to a non-participating provider?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, and if benefits are exhausted, do participate and provider discounts apply?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, for non-covered services to participate and provide a discount supply?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, and if patients not eligible for services, do participate in discounts apply.
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] OK and uh.
[CUSTOMER][NEUTRAL] Um, is there a missing two calls?
[AGENT][NEUTRAL] Yes, ma'am, and that's on your fax back that I just sent you with the benefits.
[CUSTOMER][NEUTRAL] OK, because nothing in it came in yet. I'm just waiting because she's basically here.
[AGENT][NEUTRAL] OK. Yes, ma'am.
[AGENT][POSITIVE] Oh goodness.
[CUSTOMER][NEUTRAL] OK, yeah, that's what.
[AGENT][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh, because she gave the wrong information. The information I read to you at first, that's what she provided, so that's what held her back.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Our crown bridge's restorations on Mahler is downgraded?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, and our prosperrior compass fillings downgrade to Amagan filling.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, and is predetermination mandatory?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] OK, because the other stuff I could fill out once it is, I just, we just needed a basic thing that um does she has an individual deductible?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, she does have a deductible. Let me look and see what that is.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're very welcome.
[AGENT][NEUTRAL] And this is just to verify benefits. It's not a guarantee of payment. Her calendar year deductible is $50. Let me check to see if she's paid that for you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, $50.
[AGENT][NEUTRAL] She still has her deductible left to pay.
[CUSTOMER][NEUTRAL] OK, so the remaining, um, deductible year to date is 0.
[CUSTOMER][NEUTRAL] OK, and does her deductible apply to basic and major?
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] She does not have major coverage on this policy. She just has preventative and basic and basic restorative.
[CUSTOMER][NEUTRAL] It's just based
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and on her um does she have the individual maximum?
[AGENT][NEUTRAL] Yes, it's $750 per covered insured.
[CUSTOMER][NEUTRAL] And has anything been used to date?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] OK, and it's a calendar max. OK, let me see, does she have or coverage percentage on her account?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEGATIVE] No auto OK.
[CUSTOMER][NEUTRAL] What else do we need to know right now? Um, could all quads be done in the same day?
[AGENT][NEUTRAL] Uh, depends on the, the CDT code. There are, uh, limitations that are on the fax back, uh, depending on the code, it'll have a limitation.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and does she have any history that will affect today's visit?
[AGENT][NEUTRAL] Let me look.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] No, ma'am, she's never filed a claim with us.
[CUSTOMER][NEUTRAL] OK and then.
[CUSTOMER][NEUTRAL] Um, what was the other question you asked me to find out? OK, for code 0430.
[CUSTOMER][NEUTRAL] Um, do you know the frequency for that or if it's not covered?
[AGENT][NEUTRAL] Let me look and see if it's on the fax back and just so you know when you do get the fax back if you're looking up a code and it's not on the fax back then it's a noncovered procedure.
[CUSTOMER][NEUTRAL] And the
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I know
[CUSTOMER][NEUTRAL] Not covered? OK, thank you for telling me that.
[AGENT][POSITIVE] You're very welcome. And that way, it'll help with the confusion, if any.
[AGENT][NEUTRAL] OK, uh, and that was that.
[CUSTOMER][NEUTRAL] So I didn't receive anything yet it should be here soon.
[AGENT][NEUTRAL] That was 0430.
[CUSTOMER][NEUTRAL] Let me go back um it was.
[CUSTOMER][NEUTRAL] What was it? 0431.
[AGENT][NEUTRAL] 0431. OK, let me look.
[AGENT][NEUTRAL] I do not see code 0431 on the fax back.
[CUSTOMER][NEUTRAL] So it's not covered. OK, thank you for letting me know that too. Let me put that in that covered.
[AGENT][POSITIVE] You're welcome.
[AGENT][POSITIVE] And it looks like your fax is there. I just got a notification that it's been sent successfully.
[CUSTOMER][NEUTRAL] And what was the last one?
[CUSTOMER][POSITIVE] OK, OK, thank you so much.
[AGENT][NEUTRAL] You're welcome, just so you know.
[CUSTOMER][POSITIVE] You have a you have a nice day thank you. I, I can be able to use it now.
[AGENT][POSITIVE] Well, you have a wonderful, oh, OK, cool. All right, good deal. All right. Well, Ms. [PII], if that's everything, I hope you have a beautiful day too, and we thank you for calling APL. Have a happy Easter.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] It
[CUSTOMER][POSITIVE] You're welcome.
[AGENT][POSITIVE] You're welcome, ma'am. Mhm.
[CUSTOMER][POSITIVE] Thank you same to you bye.
[AGENT][NEUTRAL] Bye bye.