AccountId: 011433970860
ContactId: 1b24205d-1cfc-44f9-8aa1-468769805517
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 328519 ms
Total Talk Time (AGENT): 153008 ms
Total Talk Time (CUSTOMER): 89416 ms
Interruptions: 1
Overall Sentiment: AGENT=1.7, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/06/1b24205d-1cfc-44f9-8aa1-468769805517_20250106T20:12_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], uh, I'm calling from a dental provider's office. I'm trying to verify a patient has a dental policy.
[AGENT][NEUTRAL] OK, you're just needing to verify if a member has an active policy or you also needing a factack of benefits as well?
[CUSTOMER][NEUTRAL] Like a fax bag, yeah.
[AGENT][POSITIVE] Yes, I can help you with that. And who am I speaking with?
[CUSTOMER][NEUTRAL] Yeah my name is [PII]
[AGENT][NEUTRAL] [PII], is that correct?
[CUSTOMER][POSITIVE] Yes, correct.
[AGENT][NEUTRAL] OK, all right, thank you. And what is your callback number?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please, sorry?
[CUSTOMER][NEUTRAL] Uh, sure, it is 02560649.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] I.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, and any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] So the patient is gonna be [PII] and her date of birth is [PII].
[AGENT][NEUTRAL] OK, now we have her last name as [PII].
[CUSTOMER][NEUTRAL] Uh, the, oh, OK.
[CUSTOMER][NEUTRAL] That is her, well, her married name is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So again on our information for her enrollment, her first name is, her last name is [PII], which is the same as the subscriber.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So that's how they have her OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, I'll let her know.
[AGENT][NEUTRAL] Yes, ma'am. Alright, so let's see.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So I do show that she is the spouse of the primary insured and this policy is active, effective [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And give me just one moment and I'll be happy to send you this fax back with her benefit information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] I will we be in network or at a network with this policy?
[AGENT][NEUTRAL] There is no network with this plan. Benefits are based on the covered services are based on a percentage of the UCR of the service region.
[CUSTOMER][NEGATIVE] No network.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is a good fax number for you, please?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 362 6.
[AGENT][NEUTRAL] OK. And will it need to be put to your attention or is that not necessary?
[CUSTOMER][NEGATIVE] Not necessary.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And again, that fax number is [PII]. Is that correct?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I have sent that fax back to you and there's also no history on file for her at this time.
[CUSTOMER][POSITIVE] OK all right thank you so much.
[AGENT][NEUTRAL] OK, you're very welcome. And then one last thing, alright, so once the claim has been processed with APL, we do have a portal in which you can check claim status and have access to the EOBs, and that website is secured.
[CUSTOMER][NEUTRAL] Sure
[AGENT][NEUTRAL] [PII] yes ma'am, [PII].
[CUSTOMER][POSITIVE] Secured.
[CUSTOMER][NEUTRAL] [PII]? OK.
[AGENT][NEUTRAL] Yes, ma'am. Uh-huh.
[CUSTOMER][NEUTRAL] And this is to submit claims?
[AGENT][NEUTRAL] That is, you can check claim status there and have access to the explanation of benefits.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][NEUTRAL] OK. All right. Well, is there, yes, ma'am. And one last thing, anything not on that fax back already means it would not be covered under their plan.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] So anything not on it is not covered. OK, got it.
[AGENT][POSITIVE] That is correct, yes ma'am. OK.
[CUSTOMER][POSITIVE] Uh, OK, thank you so much.
[AGENT][POSITIVE] You are very welcome and thank you again for calling APL if that's all I can help you with. I hope you have a nice evening.
[CUSTOMER][POSITIVE] You too thank you so much bye bye.
[AGENT][POSITIVE] You're very welcome. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.