AccountId: 011433970860
ContactId: 15396be4-8109-4467-afdd-6d1d99579a96
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 698770 ms
Total Talk Time (AGENT): 198630 ms
Total Talk Time (CUSTOMER): 250267 ms
Interruptions: 7
Overall Sentiment: AGENT=0.8, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/09/15396be4-8109-4467-afdd-6d1d99579a96_20250409T20:11_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, good afternoon. I'm calling from a provider's office at right now then, and I need to check into eligibility, please.
[AGENT][NEUTRAL] OK, sure. I can assist you with the eligibility and may I have your name?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Ms. [PII], may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number, Ms. [PII]?
[CUSTOMER][NEUTRAL] I'm sorry, what is it that you needed?
[AGENT][NEUTRAL] The policy number?
[CUSTOMER][NEUTRAL] See, that's the thing is that I don't have a policy number, so I have the dad's social and a group number.
[AGENT][NEUTRAL] OK, um, bear with me just a second. Let me go ahead and pull another system where I can use that social, um, go ahead with the social.
[CUSTOMER][NEUTRAL] Um, you want the social or patient's name? So, um, [PII].
[AGENT][NEUTRAL] The social of the main holder.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] I can't do me a favor.
[CUSTOMER][NEUTRAL] Can you she's just gonna pay 533.
[AGENT][NEUTRAL] OK, and what's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Uh, subscriber is [PII]'s gonna help me.
[CUSTOMER][NEUTRAL] It's [PII] is the subscriber.
[AGENT][NEUTRAL] What is the
[AGENT][NEUTRAL] What's the patient, patient's information?
[CUSTOMER][NEUTRAL] Patient is [PII]. Um date of birth is [PII].
[AGENT][NEUTRAL] OK. Can you repeat that date of birth one more time?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes, um, [PII]. Can you do the [PII]?
[AGENT][NEUTRAL] OK, thank you, and you said you need eligibility today, correct?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. We have an effective date of [PII].
[AGENT][NEUTRAL] It is active at the moment?
[CUSTOMER][POSITIVE] You're welcome. You have.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you need the policy number, Ms. [PII]?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, the policy number is 02.
[AGENT][NEUTRAL] 29
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 8098.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Now can I go over some calls and see if they're um.
[CUSTOMER][NEUTRAL] If the patient will be eligible for that, he needs um.
[CUSTOMER][NEUTRAL] And then can you send me a fax like a percentages and everything?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yeah, I can send you a fax back. Yeah, what is the fax number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK. [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][NEUTRAL] OK, it's gonna be to your attention.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] Yes please.
[AGENT][NEUTRAL] OK. Um, let me see, bear with me just a second.
[AGENT][NEUTRAL] Do you mind if I put you on a quick hold so I can send this fax to you right now?
[CUSTOMER][POSITIVE] Sure, no problem.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you for holding and being patient for me. OK, I went ahead and send that over to you. It should be. Hi, it should be there in a few minutes.
[CUSTOMER][NEUTRAL] Maybe she hi.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Hi. OK, sorry.
[AGENT][NEUTRAL] Hi
[AGENT][POSITIVE] It's OK. No problem. I understand. Um, yeah, I went ahead and send that over to you. It should be there in a few minutes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You still want to go over the codes?
[CUSTOMER][NEUTRAL] Oh, OK, yeah, I wanted to see, yes, I wanted to see if, um, 2740, so iron crowns, are they covered on pre-molars and molars?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK, let me check on that for me just a second.
[AGENT][NEUTRAL] OK, give me one more minute.
[AGENT][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] Where did [PII] go? [PII].
[AGENT][NEUTRAL] Are you the code was I'm sorry, can you repeat it?
[CUSTOMER][NEUTRAL] Um, for zirconia crowns, like porcelain crowns, are they covered on?
[CUSTOMER][NEUTRAL] Molars and pre-molars.
[AGENT][NEUTRAL] OK, what is that code if you have the code that will help?
[CUSTOMER][NEUTRAL] 2740.
[AGENT][NEUTRAL] 2740, OK.
[AGENT][NEUTRAL] Right, let me see
[CUSTOMER][NEUTRAL] Let me
[CUSTOMER][NEUTRAL] right
[AGENT][NEUTRAL] OK, it does, uh, it's not on the limitation. Let me ask an examiner, um, the pre, uh, bear with me just a second. Let me send this, uh, question over to an examiner.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] And then I'm sorry, do you have a group name?
[AGENT][NEUTRAL] Mhm. Yes.
[AGENT][NEUTRAL] The group name is Universal Trucking and it's gonna be under.
[CUSTOMER][NEUTRAL] I remember.
[AGENT][NEUTRAL] What division um.
[CUSTOMER][NEUTRAL] Should I call her then?
[AGENT][NEUTRAL] [PII] I T X.
[CUSTOMER][NEUTRAL] Did you say, I'm so sorry, did you say Universal Trucking?
[AGENT][NEUTRAL] Yes, Universal Trucking and the next uh name is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Which is [PII]
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then is there a waiting period for um treatment or does it have to be pre-authorized? Is it mandatory or recommended for crowns?
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] No, um, there's no pre-authorization, um, there, there is a 12 month waiting period, but this one is out of the waiting period already.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alrighty and then I'm just gonna go ahead and wait for the fax back and then I am gonna.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Wait for that and I'll go tell the patient because I need to coordinate it with the computer so I can give him, but the crowns, are they covered? What's the percentage on the crowns?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] On the crowns it's gonna be 40%.
[CUSTOMER][NEUTRAL] So you cover 40% patients responsible for 60%.
[AGENT][NEUTRAL] Yeah, and there's a $50 deductible for any major service.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] OK, thank you so much I appreciate it. May I please have your name?
[AGENT][NEUTRAL] My name is [PII]. That's [PII].
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][POSITIVE] OK, thank you so much [PII] have a good day.
[AGENT][POSITIVE] You're welcome. Um, Ms. [PII], you don't wanna wait for the answer of the seminar about the premolar and molar.
[CUSTOMER][NEUTRAL] No, because I think I'm gonna go ahead and um submit it because I don't think he's gonna start any treatment because he's not here with his mom, and if it's at 40%, then I know his fee is gonna be pretty high. So I'm gonna submit for an authorization for that.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, no problem. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] Thank you, no, that would be it for today. Thank you so much.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good afternoon. Bye bye.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK, bye.
[AGENT][NEUTRAL] No.