AccountId: 011433970860
ContactId: 122afa8c-d64f-4a70-983e-c6ce23cc2a97
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 479140 ms
Total Talk Time (AGENT): 209825 ms
Total Talk Time (CUSTOMER): 187464 ms
Interruptions: 3
Overall Sentiment: AGENT=0.6, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/27/122afa8c-d64f-4a70-983e-c6ce23cc2a97_20250227T16:35_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hey, yes ma'am. I'm just calling to get a breakdown of, um, eligibility and benefits for a patient, and I'm calling from a provider's office.
[AGENT][NEUTRAL] OK, I can verify benefits for you and your name is?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, Ms. [PII], what's that policy number, please?
[CUSTOMER][NEGATIVE] Um, the only thing I have that he said was 12317. I tried it online and it did not work.
[AGENT][NEUTRAL] Uh, sounds like more of like a group number. What's the patient's name?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] [PII], OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK one moment.
[AGENT][NEUTRAL] Let's see
[AGENT][NEUTRAL] [PII]. And this is for medical?
[CUSTOMER][NEUTRAL] Dental.
[AGENT][NEUTRAL] Dental. OK, give me one moment.
[CUSTOMER][NEUTRAL] What
[AGENT][NEUTRAL] And verify his date of birth.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, I can give you his policy number with our company when you're ready.
[CUSTOMER][POSITIVE] Um, OK, yes, I'm ready.
[AGENT][NEUTRAL] OK, it's 250-1312.
[AGENT][NEUTRAL] His effective date is [PII], and he is active on the plan and you just need a general breakdown of benefits or we can send a fax back.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, yeah, I mean, I'm gonna need a detailed, um, breakdown.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So is this number, can I use this online? I was trying to, um, I was trying to register because we've never used y'all's online portal before and it says patient account number.
[CUSTOMER][NEUTRAL] And our tax ID number.
[AGENT][NEUTRAL] Uh, yes, ma'am. As far as the online, uh, service center with our company for providers is to check claim status. So, um, if you have a
[CUSTOMER][NEUTRAL] But that
[CUSTOMER][NEUTRAL] Oh, it doesn't have a.
[AGENT][NEUTRAL] Like if he was, uh, we were to receive a claim for him and it was processed and you wanted to check status, then you'll be able to set up a provider, be able to set up on the online service center to check the claim, yes ma'am.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But um,
[CUSTOMER][NEUTRAL] Yeah, I mean, I will need to get a, I guess I'll need to get a a fax of um like the details, the detailed breakdown um but I do need to get a little bit more information from you if that's OK while I'm on the phone.
[AGENT][NEUTRAL] Oh, that's fine. And Ms. [PII], do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, and let's see, um, not a guarantee of payment, just a verification of coverage. He has a benefit max up to $1500 per calendar year and he has a $50 deductible that is applied to everything but preventative services.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, preventive pay, go ahead, I'm sorry.
[CUSTOMER][NEUTRAL] Um, has he?
[CUSTOMER][NEUTRAL] Um, has he used any of the, um, maximum for the year?
[AGENT][NEUTRAL] No, ma'am. He hasn't met his benefit max nor deductible for the year, and he doesn't have any history.
[CUSTOMER][NEUTRAL] OK, OK, and you said the percentage for preventative is 100%?
[AGENT][NEUTRAL] 100% of UCR, yes, ma'am.
[CUSTOMER][NEUTRAL] OK, um, what about basic?
[AGENT][NEUTRAL] Uh, basic, basic restorer, FMX panoramic pay 80.
[CUSTOMER][NEUTRAL] OK, a major.
[AGENT][NEUTRAL] Uh, major services which would include endo perio and oral surgery, pays at 40.
[CUSTOMER][NEUTRAL] OK, um, are implants covered?
[AGENT][NEUTRAL] No, ma'am, implants are not covered or implant crowns.
[CUSTOMER][NEUTRAL] OK, and what about orthodox orthodontics.
[AGENT][NEUTRAL] Uh, uh, let me double check, but I don't believe it's covered. Give me a moment. Oh so it's not covered under the policy.
[CUSTOMER][NEUTRAL] OK, and do you have a payer ID by chance?
[AGENT][NEUTRAL] Uh yes, ma'am. It's 60801.
[CUSTOMER][NEUTRAL] OK, and um.
[CUSTOMER][NEUTRAL] Can you check and see what the schedule?
[CUSTOMER][NEUTRAL] We need to use for this. I'm not sure if we're in network or out of network with American Public Life.
[AGENT][NEUTRAL] Uh, well, we don't have a network, um, meaning the insured can go to any provider.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and is there a group name?
[AGENT][NEUTRAL] Uh yes, give me a moment.
[AGENT][NEUTRAL] Group name is Universal Trucking, PGT Trucking.
[CUSTOMER][NEUTRAL] PGT trucking and the group number?
[AGENT][NEUTRAL] Trucking. Yes, ma'am.
[AGENT][NEUTRAL] 12317.
[CUSTOMER][NEUTRAL] OK, so that's what that number was. OK, and do you have a claims mailing address?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Uh yes, it's [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] You said I'm sorry, [PII].
[AGENT][NEUTRAL] Mhm. [PII] is the uh zip code.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And what was your name again?
[AGENT][NEUTRAL] Uh, my name is [PII], last initial [PII] And do you want that fax back sent to you, Ms. [PII]?
[CUSTOMER][POSITIVE] Yeah, I do.
[AGENT][NEUTRAL] What's your fax number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I will send this off to you in a few moments.
[CUSTOMER][NEUTRAL] OK, um, and you said there's no history on this.
[AGENT][NEUTRAL] Uh, correct. He doesn't have any history.
[CUSTOMER][NEUTRAL] Plan
[CUSTOMER][NEUTRAL] OK, um, let me see, I probably, oh, I'm sorry, is there a waiting period?
[AGENT][NEUTRAL] Uh, there is a 12-month waiting period for major services.
[CUSTOMER][NEUTRAL] OK. And is there a missing tooth cloth?
[AGENT][NEUTRAL] And yes, there is a miss [PII]lause.
[CUSTOMER][NEUTRAL] OK, and are posterior composites downgraded to amalgam or?
[AGENT][POSITIVE] Uh, there are no downgrades whether for fillings or for crowns.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and it should give me like the codes and everything on that fax back?
[AGENT][NEUTRAL] Uh, yes, ma'am.
[CUSTOMER][POSITIVE] OK, alrighty, that sounds good. I'll, um, I'll wait on the fax for all those codes.
[AGENT][POSITIVE] All right. You should receive it in a few moments. I'm working on it right now.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, that sounds good.
[AGENT][POSITIVE] Alright, Ms. [PII]. Well, thank you for calling APL and you have a great day.
[CUSTOMER][NEUTRAL] Thank you, can I please have a reference number?
[AGENT][NEUTRAL] Uh, we don't give reference numbers, but you may use my name in today's date if you like.
[CUSTOMER][POSITIVE] OK, alrighty, I will do that. Thank you so much.
[AGENT][POSITIVE] Alright, you're welcome. Thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Mm you too bye bye.
[AGENT][NEUTRAL] Bye