AccountId: 011433970860
ContactId: 07c087f3-09e0-4227-9fbf-a1d32492ca44
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 455959 ms
Total Talk Time (AGENT): 198104 ms
Total Talk Time (CUSTOMER): 274932 ms
Interruptions: 12
Overall Sentiment: AGENT=1.1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/14/07c087f3-09e0-4227-9fbf-a1d32492ca44_20250314T14:25_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Um, alright, consultation.
[CUSTOMER][NEUTRAL] Let's start with this first.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Not for treatment um that.
[CUSTOMER][NEUTRAL] And at the time.
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hello hello?
[AGENT][NEUTRAL] Yes, can you hear me?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][POSITIVE] Yes, yes I can thank you so much. I'm, I'm trying to verify uh dental insurance benefits for a patient.
[AGENT][POSITIVE] Of course, yes, I could check those benefits for you, OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Wasn't sure if somebody pocket dialed.
[CUSTOMER][NEUTRAL] No, I was actually out talking to the patient and I had you on speaker phone and trying to multitask.
[AGENT][NEUTRAL] Oh, sure.
[AGENT][NEUTRAL] Oh, I understand. um, what was your name? I'm sorry.
[CUSTOMER][NEUTRAL] My name is [PII] and I'm and I'm calling from a provider's office.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Got it. um, [PII], can I get a good call back number from you in case we're disconnected please?
[CUSTOMER][NEUTRAL] Yes, yes, [PII] and then um what was your name?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Uh, [PII]
[CUSTOMER][POSITIVE] OK, thanks [PII]. I appreciate it, um, policy certificate number is 02441264.
[AGENT][NEUTRAL] Of course, absolutely, um, and then did you have that policy number, [PII]?
[AGENT][NEUTRAL] OK and uh what was the name and date of birth for the patient please?
[CUSTOMER][NEUTRAL] It is [PII] and his date of birth is, let me get there, uh date of birth is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Perfect thank you so much for verifying that. Uh, so this policy is active. Uh, effective date was [PII], um, and if you'd like, I can, of course I'm happy to answer any questions you have over the phone. I can also send you the fax back that shows all of the covered procedures.
[CUSTOMER][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes, if I could get a fax back and then will that have like the um claims mailing address and everything like that? OK.
[AGENT][POSITIVE] Absolutely. Uh-huh.
[AGENT][NEUTRAL] Yes, it will we have a fax number, payer ID, and a mailing address, yes.
[CUSTOMER][POSITIVE] Awesome and then can you look and see if like um is this a typical plan like 180 like you know one.
[AGENT][NEUTRAL] Yes, right, so this one does just pay a percentage based off of UCR, um, so preventative at 100, basic at 80, and all majors at 40.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK and then can you look and see if my providers in network with this or do you guys not have?
[AGENT][NEUTRAL] So as
[AGENT][NEUTRAL] No networks, it's just strictly goes off of UCR.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] UCR, OK, perfect, um, and then let's see here. I just have a couple codes just, um, and yeah, is it a it so like he probably has a yearly maximum and deductible is that how this particular plan works?
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Oh sure.
[AGENT][NEUTRAL] Yes, uh, and it does go off of a calendar year, um, and of course I will let you know verification of coverage is not a guarantee of payment for claims, uh, so his calendar year maximum is $1500 that deductible is $50 and that does not apply to preventative expenses.
[CUSTOMER][POSITIVE] OK you're welcome.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK, um, let me find my codes here. Has he used anything yet?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, let me check. Give me just a moment.
[AGENT][NEUTRAL] So nothing has been used or met so far this year.
[CUSTOMER][NEUTRAL] OK, um, so can we look up, um, in like uh D7510?
[AGENT][NEUTRAL] Yes, one moment.
[AGENT][NEUTRAL] 7510 is going to be covered uh oral surgery, um, so that's at 40%.
[CUSTOMER][NEUTRAL] So you guys cover at 40%?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][POSITIVE] Perfect and then um may I give you my number for the fax back? Will that come fairly quickly? OK awesome.
[AGENT][POSITIVE] Oh yes, absolutely it should, uh, depending on how busy your machine is, yes.
[CUSTOMER][NEUTRAL] OK, OK, um, our fax number is 817.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 237-7585
[AGENT][NEUTRAL] OK, I'm going to read that back, make sure I heard that correctly. That was [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, I'm sorry, someone was talking right in my other ear. Can you repeat it one more time?
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Yes, yes, uh, so that's [PII].
[CUSTOMER][POSITIVE] Perfect. 237-758-5 yes.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Awesome. Alrighty, I will get that sent now. Um, I would say within 10 to 15 minutes at the most you should receive that. Um, did you have any other questions for me at the moment?
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, yeah, since we're on there, um, like, so oral surgery, the, the 75, like the 7140, 72, that is that gonna fall all under the 40% coverage?
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] Um, let's see, 7140 is actually under basic, um, so that's going to be at 80.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, 80 and then.
[AGENT][NEUTRAL] And what was the other one you gave me? I'm sorry.
[CUSTOMER][NEUTRAL] Um, 7210 through 7240.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Those are all under uh oral surgery, yes, so 40%.
[CUSTOMER][NEUTRAL] 72.
[CUSTOMER][NEUTRAL] 40 at 40% OK um.
[CUSTOMER][NEUTRAL] So that's the incision and train, yeah, I don't think that I'll need anything else.
[CUSTOMER][NEUTRAL] Um, perfect. OK, then I will wait for that, um, fax back to [PII]e and this just pays out of network on UCR.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Correct, um, and then of course, I'm sorry.
[CUSTOMER][NEUTRAL] And then um
[CUSTOMER][NEUTRAL] No, no, go ahead.
[AGENT][NEGATIVE] Just so that you are aware, um, if you were looking for a specific procedure on this fax back and you do not see it listed, that simply means it's not covered.
[CUSTOMER][NEUTRAL] OK, good to know good to know um OK perfect and then payer ID it's the 60,810.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] OK, 60801 um and then um like my claims that would go to American Public Life at the [PII] OK OK perfect thank you so much I really appreciate it and then that certificate number, is that his member ID number or do I need to have something different?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm, and Oklahoma City, yes, of course, yes.
[AGENT][NEUTRAL] No, no, that, that's the same, that'll work.
[CUSTOMER][NEUTRAL] The 02441264.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] OK perfect [PII] thank you so much you've been very helpful I appreciate it nope that's it.
[AGENT][NEUTRAL] Of course.
[AGENT][POSITIVE] You're welcome. Was there anything else I could help you with?
[AGENT][POSITIVE] Alright, well thanks for calling APO but uh you should be getting that fax back soon. I did just go ahead and send it and I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Thank you you too have a great weekend.
[AGENT][POSITIVE] Thank you. You too. Bye bye.
[CUSTOMER][NEUTRAL] OK bye bye.