AccountId: 011433970860
ContactId: 132b575e-132a-43b2-b5b9-07ae17c7b8a5
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 362690 ms
Total Talk Time (AGENT): 125610 ms
Total Talk Time (CUSTOMER): 108880 ms
Interruptions: 1
Overall Sentiment: AGENT=1.5, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/09/132b575e-132a-43b2-b5b9-07ae17c7b8a5_20250609T18:13_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, [PII]. My name is [PII] and I'm calling on behalf of the provider's office to know about the eligibility and benefits of a patient on a recorded line. Can you please help me with that?
[AGENT][NEUTRAL] OK, [PII], you're you're needing eligibility and benefits for a member, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] I'm so sorry. What were the last 4 numbers again, please, [PII]?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] Yes, policy number, it's.
[CUSTOMER][NEUTRAL] 02340041.
[AGENT][NEUTRAL] OK, thank you one moment while I get the member's information pulled up.
[AGENT][NEUTRAL] What type of benefits are you calling about for dental or medical?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK, dental.
[AGENT][NEUTRAL] OK, and [PII], I can help you, but for our dental policies, we have facts, facts of the member's benefits that I will send to you that will have all of their coverage.
[CUSTOMER][NEUTRAL] No, I just have some specific questions.
[AGENT][NEUTRAL] OK, just a moment.
[AGENT][NEUTRAL] And any information provided will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name, it's [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK. So I do show that she is a subscriber on this general policy. The policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] And this plan runs in a calendar year and the coordination of benefits standard, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And the group name, it's TRC Staffing, and the group number is 70055, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And in this plan, there is some missing two clause, no waiting period, right?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] It does have a missing tooth cloths and no waiting period. That is correct.
[CUSTOMER][NEUTRAL] And for the group.
[CUSTOMER][NEUTRAL] All right. And there's no major coverage, right, for this patient?
[AGENT][POSITIVE] That is correct. That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And for the plan maximum, it's $500. Individual deductible $50 right?
[AGENT][NEUTRAL] Um, let me double check that for you. One moment.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] So, can you please tell me how much has this patient used some out of it?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] And as of now for this calendar year, there have not been any benefits used?
[CUSTOMER][NEUTRAL] So is there any histories that might affect the frequency of this patient?
[AGENT][NEUTRAL] What code would you like for me to check?
[CUSTOMER][NEUTRAL] History.
[AGENT][NEUTRAL] Yes. Uh-huh. And which code would you like for me to check?
[CUSTOMER][NEUTRAL] For exams by doings.
[AGENT][NEUTRAL] OK. Just give me the code number. Yes, sir. Give me the, provide me with the code.
[CUSTOMER][NEUTRAL] FMX panel.
[CUSTOMER][NEUTRAL] All right. Here I go.
[CUSTOMER][NEUTRAL] 01200210.
[AGENT][NEUTRAL] One moment. No, we're gonna, yes, so we're gonna do them one at a time.
[AGENT][NEUTRAL] No history for 120. And what is the next code?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] 0210.
[AGENT][NEUTRAL] No history.
[CUSTOMER][NEUTRAL] 0274.
[AGENT][NEUTRAL] No history.
[CUSTOMER][NEUTRAL] 0330.
[AGENT][NEUTRAL] 619 of 24.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] 1110
[AGENT][NEUTRAL] No history?
[CUSTOMER][POSITIVE] Then I guess that's all the information I needed. Thank you so much, and we have a great day ahead. Bye-bye.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, I hope you have a great day too, and if you all do file a claim with us for her [PII] once the claim has been processed, we do have our portal that you should be able to check claim status in, and the website for that is located at [PII].
[CUSTOMER][POSITIVE] All right then. Thank you so much and we have a great day ahead. Bye-bye.
[AGENT][NEUTRAL] OK. Oh.
[AGENT][POSITIVE] I hope you have a great day too, and it was my pleasure speaking with you. Thank you again for calling APL.
[CUSTOMER][NEUTRAL] Yeah.