AccountId: 011433970860
ContactId: 16dae5d5-0db9-41e9-9735-c2e0942cd99e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 470029 ms
Total Talk Time (AGENT): 142726 ms
Total Talk Time (CUSTOMER): 158229 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/15/16dae5d5-0db9-41e9-9735-c2e0942cd99e_20250415T14:44_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thank you for calling APL this is [PII] how may I help you?
[CUSTOMER][NEUTRAL] Good morning. My name is [PII]. I'm calling from a provider's office attempting to verify eligibility and benefits for a patient. Could you assist me?
[AGENT][POSITIVE] Yes, Ms. [PII], I can help you with eligibility and benefits. May I please get your callback number just in case the call gets disconnected?
[CUSTOMER][NEUTRAL] Yes ma'am, it's [PII].
[AGENT][NEUTRAL] OK, and then what is uh the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yes, ma'am. Her name is [PII]. Date of birth is [PII], and the policy number I have is 02609097.
[AGENT][NEUTRAL] OK, thank you. And Miss [PII], what is the name of the facility you're calling from?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] It's Aspen Dental.
[AGENT][NEUTRAL] OK, let me look that patient up real quick for us.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, I do show that [PII] does have an active policy. The effective date of her policy is [PII].
[AGENT][NEUTRAL] And if you can give me your fax number, I can send you a fax back with the benefit breakdown and fee schedule for her.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] That'll be perfect. Um, let me know when you're ready.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] I'm ready, ma'am.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Alright, it's 706.
[CUSTOMER][NEUTRAL] 884.
[CUSTOMER][NEUTRAL] 6298
[AGENT][NEUTRAL] OK, thank you, Ms. [PII]. I'm gonna put you on a quick hold while I get that fax ready and I will be right back.
[CUSTOMER][POSITIVE] No problem, thank you so much.
[AGENT][POSITIVE] All right. You're very welcome.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Slow
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEUTRAL] And hygiene in the afternoon.
[AGENT][POSITIVE] Thank you so much, Ms. [PII], for holding for me. I've got that fax on its way to you now.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, um, before I let you go, I just have a couple of questions that may not be listed on the fax. Um, do you all, yes ma'am, do you all accept assignment of benefits to a nonparticipating provider?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, if benefits are exhausted, do participating provider discounts apply?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Alright, no, I'm gonna assume no discounts on anything here. And then, um, on the plan for scaling and route planning, is there a limitation as to how many quadrants we can do in a visit?
[AGENT][NEUTRAL] Uh, can you give me the CDT code, and I will look. It's on the fax back, the benefits. Now, if when you're looking at the facts back, if there isn't a uh CDT code, then it's a non-covered procedure because this policy only has preventative and basic.
[CUSTOMER][NEUTRAL] Ah, OK, plan only has preventative.
[CUSTOMER][NEUTRAL] And basic. OK. So, oh, so do you know if endoerial and oral surgery will fall under basic on the plan?
[AGENT][NEUTRAL] If you can give me a code I can look on the fax back and see if it's on there.
[CUSTOMER][POSITIVE] Perfect. OK, so the first code that I asked about is [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Another one
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Uh, well, I'll wait.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Did you want me to just give you all the codes that I might need? Because I only need 3.
[AGENT][NEUTRAL] Uh, let's do, let's do them one at a time, OK, and this is just to verify benefits. It's not a guarantee of payment. I do not see code 4341 on the fax.
[CUSTOMER][POSITIVE] OK, no problem.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Alright, what about 3330?
[AGENT][NEUTRAL] Let me look for that one.
[AGENT][NEUTRAL] I do not see 3330. I have 330 panoramic.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, yeah, it's an X-ray. Um, I figured that might be covered since it might be preventative or basic on the plan. Uh, what about uh 4910?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, let me keep looking.
[AGENT][NEUTRAL] No, ma'am. 4910 is not on.
[AGENT][NEUTRAL] The schedule of benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then what about 70 to 10?
[AGENT][NEGATIVE] That is not covered either.
[CUSTOMER][NEUTRAL] Alright, and then since it it's only a basic and preventative plan I know that everything else really won't be covered. I won't really need those frequencies right now, um, this is just a preventative and basic plan do you all require predetermination on those services?
[AGENT][NEUTRAL] No ma'am.
[CUSTOMER][NEUTRAL] Alrighty, and may I just have a reference number for the call? I'll just wait on that fax, but.
[AGENT][NEUTRAL] Yes, ma'am. You can use my name. It's [PII] and today's date.
[CUSTOMER][POSITIVE] Alright, Ms. Try, thank you so much for your time this morning.
[AGENT][POSITIVE] You're very welcome, Ms. [PII]. Is there anything else I can help you with before we go?
[CUSTOMER][NEUTRAL] No, ma'am, just gonna wait on that fax back.
[AGENT][POSITIVE] OK, well you have a wonderful rest of your week and thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you ma'am you do the same.
[AGENT][POSITIVE] Thank you. Bye-bye, ma'am.