AccountId: 011433970860
ContactId: 13583327-5ca3-4545-aaa8-cc6e7ec48366
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 361660 ms
Total Talk Time (AGENT): 124175 ms
Total Talk Time (CUSTOMER): 135394 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/19/13583327-5ca3-4545-aaa8-cc6e7ec48366_20250319T16:25_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh yes, my name is [PII] and I'm calling from the dental office trying to get some eligibility and benefits on a patient. Could you please spell your first name?
[AGENT][NEUTRAL] Um, it's [PII], um, it's spelled [PII] and my last initial is [PII].
[CUSTOMER][POSITIVE] All right thank you so much.
[AGENT][POSITIVE] No problem. And could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Thank you, [PII]. Now, could I get the policy number, please?
[CUSTOMER][NEUTRAL] 127768411
[AGENT][NEUTRAL] OK, please repeat that number.
[CUSTOMER][NEUTRAL] 127768411
[AGENT][NEUTRAL] OK. That's actually not one of our policy numbers. There's too many digits. Um, I could try to look them up by the social.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] I don't have that's all the number they gave us and then they gave me it's either a group or a plan number which is 14564.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, yeah, that sounds like a group number. Um, I could try to look them up by name and date of birth. What's the last name?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And the first name?
[CUSTOMER][NEUTRAL] You want the policy or the patient?
[AGENT][NEUTRAL] Um, the policy.
[CUSTOMER][NEUTRAL] X A
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and please verify the subscriber's date of birth.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I found the policy in our system and please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And her date of birth is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and just let me advise you that verification of coverage does not guarantee payment of claims. Um, I have the policy number here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The policy number is 025.
[AGENT][NEUTRAL] 74652.
[CUSTOMER][POSITIVE] Alright, thank you so much.
[AGENT][NEUTRAL] Mhm. No problem. And the effective date on this policy was [PII] and the policy is still active. And for a list of the benefits and the fee schedule, I can fax that over to you.
[CUSTOMER][NEUTRAL] OK, alright, and then.
[CUSTOMER][NEUTRAL] OK, hold on one second, let me write this number down before I lose it on this piece of paper.
[AGENT][NEUTRAL] I understand.
[CUSTOMER][NEUTRAL] OK and then.
[CUSTOMER][NEUTRAL] Are we in or out of network though?
[AGENT][NEUTRAL] Um, we work with our providers. There is no network. Um, this policy works as a PPO plan.
[CUSTOMER][NEUTRAL] OK, so we would just follow our office fee schedules?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, the payer ID and the claims mailing address is on that on the fax?
[AGENT][NEUTRAL] Um, let's see, let me make sure.
[AGENT][NEUTRAL] Yes, ma'am. It's on the fax.
[CUSTOMER][NEUTRAL] OK, and what is the group name on the policy?
[AGENT][NEUTRAL] The group name is.
[AGENT][NEUTRAL] The group name is Universal Trucking Anderson.
[CUSTOMER][NEUTRAL] Universal.
[CUSTOMER][NEUTRAL] Trucking Anderson.
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, and then does it show if there's any pending claims on the on the fax?
[AGENT][NEUTRAL] No, ma'am, it doesn't, but I can check.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] And I'm not showing any pending claims on file.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Is a prior off required or just suggested?
[AGENT][NEUTRAL] No, ma'am. There isn't.
[CUSTOMER][NEUTRAL] And is a medical denial required or does all the claims come straight to dental?
[AGENT][NEUTRAL] Yes, our claims go straight to dental.
[CUSTOMER][NEUTRAL] OK, and is there a coordination of benefits on the policy?
[AGENT][NEUTRAL] No, there isn't.
[CUSTOMER][NEUTRAL] And is this [PII]'s primary insurance?
[AGENT][NEUTRAL] Yes, I'm showing that it is.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, I will look on the fax, and what else I don't need what else I miss on it, then I will call back.
[AGENT][NEUTRAL] OK, and your fax number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. So that's attention, [PII]. [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes ma'am, and then can I get a reference number for our call?
[AGENT][NEUTRAL] Um, yes, for the reference number, you can use my name and today's date. Is there anything else that I can assist you with?
[CUSTOMER][NEGATIVE] No thank you.
[AGENT][POSITIVE] OK, thank you, [PII], for calling APL. You have a great rest of your day. Bye.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Mm thank you.