AccountId: 011433970860
ContactId: 0b6c09e8-1a4b-4737-8fdb-3937e972288a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 319980 ms
Total Talk Time (AGENT): 154968 ms
Total Talk Time (CUSTOMER): 94685 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/0b6c09e8-1a4b-4737-8fdb-3937e972288a_20250422T14:10_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling to get a patient um benefits.
[AGENT][NEUTRAL] OK, well, I can definitely help you with the benefits and [PII], may I have a good contact number in case we're disconnected and the member's policy number?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Phone number is [PII] and the policy number is 607224.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII] Was date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that. And all the information provided is a verification of benefits, not a guarantee of payment. So I am showing that the policy is active and it's been effective since [PII]. And let me see what type of policy they have. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, and the benefits just populated, um, did you need a copy of the fax back or did you have particular questions?
[CUSTOMER][NEUTRAL] Can I have a copy of it and I do have a couple questions.
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] OK. What's a good fax number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And should I put attention, [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] [PII]. All right, so I just faxed that over to you and then what questions did you have?
[CUSTOMER][NEUTRAL] Um, how does this policy work? We have a couple patients with this policy. Is it like a fee schedule co-payment plan, um.
[CUSTOMER][NEUTRAL] How do we determine the patient's portion or like our reimbursement?
[AGENT][NEUTRAL] So, um, basically you'll see the calendar year max and deductible and then all the frequencies and everything. There's a list of codes and then the benefit amount that will be applied towards that code.
[AGENT][NEUTRAL] So it's not really like a
[CUSTOMER][NEUTRAL] Is that what y'all reimburse?
[AGENT][NEUTRAL] Right, that's what we would pay towards that code.
[AGENT][NEUTRAL] So it's not really like a
[CUSTOMER][NEUTRAL] What, how do I determine the patients, how do I determine the patient's co-payment?
[AGENT][NEUTRAL] There's no copay for our policies.
[CUSTOMER][NEUTRAL] So everything's at 100%?
[AGENT][NEUTRAL] No, so this is not like a standard fee schedule. So for example, if they come if they
[AGENT][NEUTRAL] An adult and they come for a trophy. So 01110, the policy will pay $40. So there's not like a percentage or UCR there's codes and the amount we pay towards that code for this policy.
[CUSTOMER][NEUTRAL] So the patient has a filling like a 2391.
[CUSTOMER][NEUTRAL] And then y'all reimburse a certain amount. What does the patient pay?
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] So for 2391, hold on, let me find that code on the fax 2.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I stepped on it yesterday and it.
[AGENT][NEUTRAL] OK, I don't even see 2391 as a covered code on here. Um, what did you say it was for? Maybe it's a different code.
[CUSTOMER][NEUTRAL] Like a filling
[CUSTOMER][NEUTRAL] A feeling like a 2140.
[AGENT][NEUTRAL] Alright, so $2140 is here and the policy will pay up to $30. So,
[AGENT][NEUTRAL] The patient responsibility will be whatever the difference is, um.
[AGENT][NEUTRAL] I, I don't know how much a filling would cost, but that's how much the policy would pay towards it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] Alright, so I see some patients like a select dental fee schedule attached to their charge. I didn't know what select dental was.
[CUSTOMER][NEUTRAL] Is that the
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Because some, some policies.
[AGENT][NEUTRAL] So there's different types of.
[CUSTOMER][NEUTRAL] To determine like some policies determine the patient's co-payment, you would take like the fee schedule subtracting what the insurance will pay, and that would be the patient's co-payment.
[AGENT][NEUTRAL] OK. Um.
[CUSTOMER][NEUTRAL] Or do we base up our our cash fees?
[AGENT][NEUTRAL] So for our policies, because they can have a, they they can have other dental policies or they can have dental policies with their major. For this policy, there's no co-pays. We would just apply what the policy says for that code and then on the fax back, I mean, I'm sorry, on the explanation of benefits, it would list the patient responsibility.
[CUSTOMER][POSITIVE] OK, alright, thank you.
[AGENT][POSITIVE] You're welcome, [PII]. Was there anything else I can help you with today?
[CUSTOMER][POSITIVE] That is it thank you.
[AGENT][POSITIVE] Alright, thanks for calling APL. Bye bye.
[CUSTOMER][POSITIVE] Thank you bye bye.