AccountId: 011433970860
ContactId: 0e976adb-55cb-47bd-aea0-10fbfe63d478
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 616150 ms
Total Talk Time (AGENT): 210249 ms
Total Talk Time (CUSTOMER): 201955 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/15/0e976adb-55cb-47bd-aea0-10fbfe63d478_20250515T15:38_UTC.wav
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[AGENT][POSITIVE] Good morning. Thanks for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Uh yes ma'am. My name is [PII]. I'm calling from Slainsboro Dental Center and I have a mutual patient that I need to check on I need to verify eligibility and check on a predetermination.
[AGENT][NEUTRAL] OK, I can verify eligibility for you, Ms. [PII], and what is that policy number, please?
[CUSTOMER][NEUTRAL] Um, yes, that policy number is going to be 1 2nd.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, that policy number is 01691413.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Uh, callback number is [PII].
[AGENT][POSITIVE] OK, thank you, ma'am. Give me one moment.
[AGENT][NEUTRAL] And verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] Um, [PII], date of birth [PII].
[AGENT][NEUTRAL] OK, I'm showing her or I'm sorry, his effective date is [PII] and he is active on the policy.
[CUSTOMER][NEUTRAL] The [PII].
[AGENT][NEUTRAL] And what other information were you needing, Ms. [PII], I'm sorry.
[CUSTOMER][NEUTRAL] Alright, yes ma'am. So he's currently active. Um, how about his remaining max and deductible?
[AGENT][NEUTRAL] OK, let me see.
[AGENT][NEUTRAL] OK. Uh, so he has met his deductible for the year.
[AGENT][NEUTRAL] And he has remaining of $1,464 for his benefit.
[CUSTOMER][NEUTRAL] 1,461464.
[AGENT][NEUTRAL] 1464 remaining. Yes, ma'am.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Alright, yes ma'am, and then the only other thing that I need, um, if we send in a predetermination for this patient on data service 59-2025 for the total amount of, let's see, the total amount of.
[CUSTOMER][NEUTRAL] 2048 and I was checking to see if that's been determined.
[AGENT][NEUTRAL] OK, and what's the name of the dental office?
[CUSTOMER][NEUTRAL] Uh, Slainsboro Dental Center.
[AGENT][NEUTRAL] OK and the name of the provider?
[CUSTOMER][NEUTRAL] Uh, Doctor [PII].
[AGENT][NEUTRAL] OK, give me one moment.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] Give me one moment.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] I apologize. My computer is moving a little slow. Uh, what were the procedure codes? Cause I do show a predeterminations sent, um, in that amount.
[CUSTOMER][NEUTRAL] Uh, 2750, um 33 33 10 and 2950.
[AGENT][NEUTRAL] OK, yes ma'am.
[AGENT][NEUTRAL] Uh, do show a predetermination was received and it was processed on today, so it will go out tomorrow.
[CUSTOMER][NEUTRAL] and um for the root canal, the 3310 and the 2950, um what's the out of pocket amount on those two?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, let's see those are major, so it pays at 40% of UCR. All it shows is just it's been processed, but it doesn't show like um.
[AGENT][NEUTRAL] Amount payable unless I look at the UCR for those codes.
[AGENT][NEUTRAL] Um, and what was the other?
[AGENT][NEUTRAL] 2950.
[AGENT][NEUTRAL] Uh, what is the zip code?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK thank you give me one quick moment.
[AGENT][NEUTRAL] Uh, 02.
[AGENT][NEUTRAL] Uh give me one moment.
[AGENT][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, um.
[AGENT][NEUTRAL] Well, this is not a guarantee of payment, just a verification of coverage, um.
[AGENT][NEUTRAL] The UCR amount for the 3310 is 365.20.
[AGENT][NEUTRAL] And for the 2950 is 15,360.
[CUSTOMER][NEUTRAL] The 2950 was one, what was that amount? I'm sorry, ma'am.
[AGENT][NEUTRAL] 15,360.
[CUSTOMER][NEUTRAL] 15,360 for 2950 and for 3310 it's 36,520.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, and how about that UCR for 2750?
[AGENT][NEUTRAL] 2750 let's see.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] See.
[AGENT][NEUTRAL] I'm showing the UCR amount for that one is 598.
[CUSTOMER][NEUTRAL] Alright, yes ma'am, so.
[CUSTOMER][NEUTRAL] For those three amounts, the 15,360, the 598, the 63,520, excuse me, the 365 20 times that 0.60 and that would be my patient out of pocket amount.
[AGENT][NEUTRAL] Well, actually it's um those are major services and they pay at 40%, but the amount that I gave you is after that um 40 is the 40% of that UCR total.
[CUSTOMER][NEUTRAL] Oh, so those amounts are not the, the full amount that's the 40% of the amount.
[AGENT][POSITIVE] Correct. Yes, ma'am.
[CUSTOMER][NEUTRAL] Got you. So let's see.
[CUSTOMER][NEUTRAL] Now, I would have to time it. 60 to get the pay. Are you doing it by the 60% because insurance pays 40, right?
[AGENT][NEUTRAL] Uh, yes, with this policy, major is at 40% of UCR.
[AGENT][NEUTRAL] For major.
[CUSTOMER][NEUTRAL] Right, so insurance will pay 40 and patient would be responsible for 60.
[AGENT][NEUTRAL] Uh, the balance be patient responsibility.
[CUSTOMER][NEUTRAL] So the calculations that you did, did you do it at the 60%?
[AGENT][NEUTRAL] No, I did it at the 40% since we pay 40% of UCR, the UCR amount for each one I multiply them by 40%. But if you need to just a flat UCR amount, I can give those to you.
[CUSTOMER][NEUTRAL] OK, so I'm trying to
[CUSTOMER][NEUTRAL] OK, yes, so I
[CUSTOMER][POSITIVE] Yes, please, if you don't mind.
[AGENT][NEUTRAL] OK, uh, the 3310, the UCR amount is 913.
[AGENT][NEUTRAL] For the 2950, the UCR amount is 384.
[AGENT][NEUTRAL] And for the 2750, it's 1,495.
[CUSTOMER][NEUTRAL] 1, 1400.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][POSITIVE] All right, yes ma'am.
[CUSTOMER][POSITIVE] Alright, perfect. Yes, ma'am. Well, I believe that is all I needed then um how do a reference number.
[AGENT][NEUTRAL] Uh, if you like, you may use my name at today's date.
[CUSTOMER][NEUTRAL] And what was your first name, ma'am?
[AGENT][NEUTRAL] Uh, it's [PII], last initial [PII].
[CUSTOMER][POSITIVE] All right, thank you so much.
[AGENT][POSITIVE] Uh, yes, ma'am. Thank you for calling APL and you have a great day.
[CUSTOMER][POSITIVE] Thank you, you too.
[AGENT][NEUTRAL] Bye.