AccountId: 011433970860
ContactId: 218669ad-bb6c-4e02-8e6b-98d0fb8ba2d6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1033358 ms
Total Talk Time (AGENT): 384820 ms
Total Talk Time (CUSTOMER): 268517 ms
Interruptions: 4
Overall Sentiment: AGENT=0.2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/16/218669ad-bb6c-4e02-8e6b-98d0fb8ba2d6_20250516T21:36_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Hello, [PII]. This is [PII]. I'm calling on behalf of the dental office to check on patients' eligibility and benefits. Can you assist me with that?
[AGENT][POSITIVE] Sure, I can help you with eligibility. Can I get your name one more time?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] And can I get a good call back in case we get disconnected, [PII]?
[CUSTOMER][NEUTRAL] Yes, it'll be [PII].
[AGENT][POSITIVE] Thank you so much. And the policy number?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Uh, you mean the ID number?
[AGENT][NEUTRAL] Yes, it might say policy certificate number on it. Mhm.
[CUSTOMER][NEUTRAL] Yeah. OK.
[CUSTOMER][NEUTRAL] OK. So the subscriber ID will be 02558868.
[AGENT][NEUTRAL] OK, let me check on that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And can I get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Sure. The first name is [PII] and last name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] Welcome.
[AGENT][NEUTRAL] Alright, I'm showing that this policy, oh hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] All right. Sorry about that.
[AGENT][NEUTRAL] I'm showing that this policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And are you wanting a fax back for the benefits or um was there a particular procedure you'd like me to look up?
[CUSTOMER][NEUTRAL] Uh, yes, if you can send me the fax also, I would really appreciate it. And also, I want to confirm the information for this policy.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] You want, I'm sorry, you wanted to confirm what?
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Yeah, a few information only.
[AGENT][NEGATIVE] You keep break you keep breaking up every time. I'm so sorry. Every time that I need to hear the part that you're, you're explaining, it breaks up. One more time, what information are you needing?
[CUSTOMER][NEUTRAL] So, yeah.
[CUSTOMER][NEUTRAL] Yeah, I'm needing like, I have a few questions regarding this policy if you can send me the fax like I can take all those frequencies and everything from the fax, but uh yeah, a few information only.
[AGENT][NEGATIVE] OK, yes. Sorry, every time I was trying to hear you, yeah, every time I was trying to hear you, it was breaking up on me, so give me one second.
[CUSTOMER][NEUTRAL] Did you get that?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Oops.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right. It looks like for [PII].
[AGENT][NEUTRAL] I will send you the fax back, but I also want to let you know that she has a deductible of $50 and a calendar year maximum of up to $500 that has not been used yet. This is a verification of benefits and not necessarily a guarantee of payment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and I can give you a quick breakdown as well. Uh, preventative expenses are 100% of allowable. Radiographs, including FMX expenses are 80% of allowable, uh, and also basic expenses and basic rest restorative expenses are at 80% allowable.
[AGENT][NEUTRAL] And then that'll all show on the fax back as well. um I just wanted to go ahead and give you that over the phone.
[AGENT][NEUTRAL] And is there anything else? Um, I need the fax number, but is there anything else before that?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That you now.
[CUSTOMER][NEUTRAL] Um yeah. Can you confirm the group name and number? Because the last verification says like no group name.
[AGENT][NEUTRAL] Sure, let me look it up.
[AGENT][NEUTRAL] The group number is 70055 and it's TRC Staffing Services. You might also hear um the term BIC.
[AGENT][NEUTRAL] Um, and that's another, that's another name that people call uh this employer number, so it's also a big number.
[CUSTOMER][NEUTRAL] Oh like that's the group name Big.
[AGENT][NEUTRAL] Big or TRC staffing services.
[CUSTOMER][NEUTRAL] Uh, is it T as in Tango?
[AGENT][NEUTRAL] Yes, T as in Tango, R as in Romeo, and C as in cat.
[CUSTOMER][NEUTRAL] OK, got it. So that big is like doing business as uh BIG?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] B I C as in cat.
[CUSTOMER][NEUTRAL] Oh, I see.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm sorry. Thank you for that. So, yes. And also, uh, does this plan have any downgrades for the fillings and crowns?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] I'm looking just a moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Do you have a possible CD CDT code for any of those so I can give you the correct information.
[CUSTOMER][NEUTRAL] Uh yeah.
[CUSTOMER][NEUTRAL] So for fillings, it's 2393.
[AGENT][NEUTRAL] OK, and the other one?
[CUSTOMER][NEUTRAL] 2740.
[AGENT][NEUTRAL] All right, let me look that up real quick.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm looking at the last one.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I don't see 2740.
[AGENT][NEUTRAL] Um, I might be overlooking it, so give me just a second.
[AGENT][NEUTRAL] I'm not seeing that. I'm seeing a 0274, but not 2740. I can give you the 2393.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, you can replace existing only if in place for 24 months.
[AGENT][NEUTRAL] And it's a maximum of 1 tooth per 24 months.
[AGENT][NEUTRAL] And that will also be on the fax back I I sent you, or I will send you after this.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, but yeah, I'm not seeing the other one.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm not seeing the other one on here though.
[CUSTOMER][NEUTRAL] Um, isn't maybe like it's, it's.
[CUSTOMER][NEUTRAL] It's downgraded or something like into a 2750 or something, 2751.
[AGENT][NEUTRAL] OK, let me see.
[AGENT][NEUTRAL] And this is for a filling correct?
[CUSTOMER][NEUTRAL] Uh, actually, that's for the porcelain crown.
[AGENT][NEUTRAL] Oh, crown, OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I'm not seeing it maybe when I send you the fax back you'll be able to see it better, um.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, because I'm not, I'm not seeing either of those on here.
[CUSTOMER][NEUTRAL] Oh, that's OK. I'll just check.
[AGENT][NEUTRAL] OK, um, what's a good fax number for this?
[CUSTOMER][NEUTRAL] OK. And uh does this policy
[CUSTOMER][POSITIVE] I'm so sorry.
[CUSTOMER][NEUTRAL] Uh, does this policy have any like, uh, missing two calls or waiting periods?
[AGENT][NEUTRAL] This policy does does have a missing tooth clause, um.
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] TMJ services are not covered, orthodontic treatment is not covered, implant replacement and removal, and all of those related services are not covered, and it looks like there is no waiting period.
[CUSTOMER][POSITIVE] OK, thank you so much for that.
[CUSTOMER][NEUTRAL] And crowns are paid on like the major services are paid on the seat date, right?
[AGENT][NEUTRAL] I'm sorry, what was that?
[CUSTOMER][NEUTRAL] Uh, major services, are they paid on sea date or prep date?
[AGENT][NEUTRAL] Oh, give me one second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you say uh C date?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what was the other one?
[CUSTOMER][NEUTRAL] Uh, yeah, it's like for crowns, uh, they paid on the seat date or on the preparation date.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me check on that for you.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Because I believe
[AGENT][NEUTRAL] Services will have to be rendered first.
[AGENT][NEUTRAL] It's just whenever you submit the claim.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, got it. Thank you for that. And
[AGENT][NEUTRAL] So we don't go off of those. Mhm.
[CUSTOMER][NEUTRAL] Uh-huh. Uh, what about like history? Will it be available on the fax or you have to provide that to me?
[AGENT][NEUTRAL] Uh, you needed the history?
[CUSTOMER][NEUTRAL] Yes, history that will affect, especially for the preventive services.
[AGENT][NEUTRAL] Uh, as I mentioned earlier, they haven't used any of their benefits yet, so there's no real history on file for this year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] In the previous years as well for like the FMX in the previous 5 years.
[AGENT][NEUTRAL] OK, let me look that up.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] It looks like they have not used.
[AGENT][NEUTRAL] This policy since they received it, so it should be and the effective date was um [PII] so we've only got one year history and it doesn't look like they've done anything yet.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, thank you so much and generally now for confirming that. I'm really sorry for the inconvenience. Actually, I'm not sure what's on that fact, so that's why I have to ask.
[AGENT][NEUTRAL] Oh, no, I'm, I'm sorry. It's every time I try to hear you, something cuts out and so I'm just trying to, you're gonna be repeating yourself a lot, so I, I apologize for that.
[CUSTOMER][NEUTRAL] Yeah,
[CUSTOMER][NEUTRAL] That's OK. Actually, yeah, it happens, it happened to me also like just yesterday also like this rep like was saying, I, I, I asked, is this patient active? And she said, this patient is dead. It's, it just went like that.
[AGENT][POSITIVE] Yeah, it's always right when you need the information.
[CUSTOMER][NEGATIVE] It's that's over and over. Oh my God.
[AGENT][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] Yeah, that's right. Yeah. Shall I provide you the
[AGENT][NEUTRAL] When we send you the fax back if there's any more, if there's any more questions after you receive the fax back, feel free to give us a call, um, since I didn't see crowns on the fax back and if and if you take a look on there and you don't see them then it it's just not covered um you can file a claim for it, but it'll get, it'll get denied um because it's not if it's not on the fax back, uh, we don't, we don't provide uh payment for it.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, and like I said, I don't see it, but maybe you'll be able to see it a little bit better, um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, are you ready for that fax number?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, it'll be [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Did you get that?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, um, expect it in maybe 5 to 10 minutes. Um, sometimes it takes a little bit longer, especially towards the end of the day, just because it's the end of the day, and I think our computers like to go on weekend break a little soon, so expect it in a couple of minutes. All right?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. So this traffic with the fax also. Thank you for that, [PII]. So, can I have a reference number?
[AGENT][NEUTRAL] So we don't do reference numbers, but you can use my name in today's date. So my name will be [PII], and then today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. Uh, that's the same initial for me also. Uh, it's [PII]
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I get called [PII] a lot.
[CUSTOMER][POSITIVE] OK, thank you so much, [PII].
[CUSTOMER][NEUTRAL] Oh yeah, sometimes me also they call [PII], something like that, but it's OK.
[AGENT][NEUTRAL] We, we just go with what we hear.
[CUSTOMER][POSITIVE] So yes, that will be all for mine for now.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Yeah, so yes, [PII], it was nice talking to you. So you have a great rest of your day and happy weekend.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] You too and have a great weekend. Thank you for calling ATL.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Mhm. Bye-bye.