AccountId: 011433970860
ContactId: 0f14fc20-4a6a-48bc-a721-508a09de6206
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 411029 ms
Total Talk Time (AGENT): 159647 ms
Total Talk Time (CUSTOMER): 113388 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/0f14fc20-4a6a-48bc-a721-508a09de6206_20250429T14:46_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], um, my name is [PII]. I'm calling from a provider's office, [PII] I sent. I am not sure if I'm in the right place. I am trying to get some information about a patient's plan, but I have very little information.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. Uh, well, I can try to help you with the information you need, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Thank you for that. And what information do you have for the member like?
[CUSTOMER][NEUTRAL] So I have um.
[CUSTOMER][NEUTRAL] I have what the the insurance name is I think what where the claims go to if I were to file a claim, the card that she uploaded, I can't read it but I can see like the bigger things so the um.
[CUSTOMER][NEUTRAL] The insurance is through Hamilton Riker.
[CUSTOMER][NEUTRAL] It uses the multi-plan network for medical and then I see benefits in a card.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is where we have to send claims to.
[CUSTOMER][NEGATIVE] Um, the patient did give us an ID number, but I have been unsuccessful in finding anything with this number.
[AGENT][NEUTRAL] OK, what's the um number?
[CUSTOMER][NEUTRAL] It's D as in Delta 404-09168.
[AGENT][NEUTRAL] OK, so that's for 90 degree benefits. Do you see anywhere on the card, or can you see anywhere on the card that says uh in hospital or outpatient policy er number?
[CUSTOMER][NEGATIVE] No, any of that like the writing I just, I, it's so blur like blurry I can't make it out.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, it's OK. And you said the um provider or I'm sorry, the their employer is [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so let's try that. Hold on one moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And what's the member's first and last name?
[CUSTOMER][NEUTRAL] [PII] last name is spelled as [PII].
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] All right, can you verify her date of birth?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Alright, so I found the policy. So all the information provided is a verification of benefits, not a guarantee of payment. So her policy number is 261.
[AGENT][NEUTRAL] 4561.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] This is a dental policy. It's been active since December, I'm sorry, since [PII].
[AGENT][NEUTRAL] And let me see what type of policy she has. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm waiting for it to come up now hold on one moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] I forgot to put the, to write down the policy number that I just gave you, so I had to go back. I'm sorry.
[CUSTOMER][POSITIVE] No worries.
[AGENT][NEUTRAL] OK. So, the, if you needed a copy of the fax back, I can fax it over to you. Um, but basically, the, it's a $500 per calendar year max.
[AGENT][NEUTRAL] Um, there is a $50 deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The policy covers preventative at 100%.
[AGENT][NEUTRAL] Um, radiographs and FMX expenses are at 80%.
[AGENT][NEUTRAL] Basic and basic restorative are both at 80 as well.
[AGENT][NEUTRAL] Um, major expenses are not not covered on this policy. Um, for us, that includes endodontic, perdontic, proteodontic, and oral surgery.
[AGENT][NEUTRAL] Um, profies and cleanings are once every 6 months.
[AGENT][NEUTRAL] Oral evaluations are 2 for 12-month period.
[AGENT][NEUTRAL] Um, 120, 40, 50, and 60 are paired together with that frequency for the evaluation.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Bite wings are once per twelve-month period.
[AGENT][NEUTRAL] And full mouth X-rays and panels are once every 5 years.
[AGENT][NEGATIVE] Um, there is no history on file.
[AGENT][NEUTRAL] And the fax back then gives the exclusions, all the ways to file a claim, and then there's a list of codes. If the code you're looking for is not on this list, then it wouldn't be covered by the policy.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is the uh the dental plan the only one that you're seeing on there?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Is the dental plan the only plan you're able to um to see is that the only one that comes up for you?
[AGENT][NEUTRAL] Let me see. Yes, that's the only policy she has with us.
[CUSTOMER][POSITIVE] Got it. OK, all right, I think that is um all that I will need today. Thank you for taking a look. I appreciate your time.
[AGENT][POSITIVE] You're very welcome and thank you so much for calling APL Vienna. I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you you too bye bye.
[AGENT][NEUTRAL] Bye bye.