AccountId: 011433970860
ContactId: 23e1508d-6697-43fc-aebc-1b9d23d185a8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 455549 ms
Total Talk Time (AGENT): 208475 ms
Total Talk Time (CUSTOMER): 148638 ms
Interruptions: 3
Overall Sentiment: AGENT=1.5, CUSTOMER=1.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/25/23e1508d-6697-43fc-aebc-1b9d23d185a8_20250425T16:37_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I am just calling to get verification for a couple of patients.
[AGENT][NEUTRAL] OK, you have 2 patients that you're needing to verify eligibility, eligibility and benefits.
[CUSTOMER][NEUTRAL] Yes. Yes, siblings.
[CUSTOMER][NEUTRAL] Eligibility and benefits please.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And the policy number?
[CUSTOMER][NEUTRAL] 02284276
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and are you calling for dental eligibility and benefits?
[CUSTOMER][NEUTRAL] Dental, yes, mhm.
[AGENT][NEUTRAL] OK, so yes, ma'am. I can help you with that. Now on our dental policies, [PII], we have fax backs of the benefits for the number that I will send to you. Do you need a separate fax back for each of them, or do you need one with both of their names on there be sufficient?
[CUSTOMER][POSITIVE] That's perfect.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] As long as both names are on it, that is totally fine.
[AGENT][NEUTRAL] OK, I think maybe I can make that work. We'll see in just a moment. So any information, [PII] that I do provide for you will be a verification of benefits and not a guarantee of payment. What are your patients' names and their dates of birth?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is for [PII] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And [PII] [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so I do show that both children are covered on this dental plan and it is active with an effective date of [PII].
[AGENT][POSITIVE] And if you'll give me just a moment, [PII] to get this back back um information pulled up, I'll be happy to send that to you.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And will it need to have your attention on it or is that not necessary?
[CUSTOMER][NEUTRAL] No, that's fine. No, you're, you're OK, yes ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is, um, the fax number for you, please?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and again that fax number, I'm just gonna repeat it to make sure I heard you correctly. [PII].
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] All right, so I have just sent that to you so you should be receiving that very soon.
[CUSTOMER][POSITIVE] Perfect thank you so much.
[AGENT][NEUTRAL] And there's not any type of technical glitch and process the claim here at APL. We do have a portal in which you should be able to check claim status in.
[AGENT][NEUTRAL] And the website for our portal is located at [PII].
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You are certainly so welcome. And is there anything else that I can help you with today?
[CUSTOMER][NEUTRAL] Um, that, uh, actually, can you just double check on, so I'm looking at an EOB and it's giving me a remark from their last cleaning and it's giving me a remark of one, but it's not showing what the one means, so like.
[AGENT][NEUTRAL] That's on page 2 or on the back. There's 2 pages.
[CUSTOMER][NEUTRAL] Yeah, that's scanned, yeah, and it's not it's scanned in and it's not there.
[AGENT][NEUTRAL] So they didn't
[AGENT][NEUTRAL] Oh, OK. They didn't image both sides of it? OK.
[CUSTOMER][NEUTRAL] Yeah, there's
[CUSTOMER][NEUTRAL] No, well, it's, it's there it's image, but it's just there's there's no number it just says remark and the description, but there's no like anything input there.
[AGENT][NEUTRAL] Mm, OK. So, um, which child is it that you're inquiring about?
[CUSTOMER][NEUTRAL] So, um, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And it's just for the code of 1206.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I just wanna see if they if that's gonna be eligible for this time or if it's like a one.
[AGENT][NEUTRAL] What's the date of service on that claim?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] uh, sorry, let me get back [PII].
[CUSTOMER][NEUTRAL] It did the same on Sister too, uh.
[AGENT][NEUTRAL] OK, so.
[AGENT][NEUTRAL] Alright, just a second.
[AGENT][NEUTRAL] Bear with me just a moment here.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so for [PII] [PII]. OK.
[AGENT][NEUTRAL] OK, so on this claim, there was a $310.80 benefit paid.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Does she have access to her phone?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] So if you call her, we're gonna send her a text of a form to fill out real quick and just add him on there I'd go and get his ID.
[AGENT][NEUTRAL] And you said it was on 1206?
[CUSTOMER][NEUTRAL] Do what? I'm sorry.
[CUSTOMER][POSITIVE] Uh, 12:06, yes ma'am, you said that right. It just sounds funny. Sorry, I was right, so sorry.
[AGENT][NEUTRAL] Yeah, one, yes, ma'am. Yeah.
[AGENT][NEUTRAL] That's OK. I know. That's OK. So, yes, ma'am, that was denied because this policy does not provide benefits for any procedure or service not listed in the schedule.
[CUSTOMER][NEUTRAL] Uh, it's Friday.
[CUSTOMER][NEUTRAL] So the 1206 code is not.
[AGENT][NEUTRAL] It's not covered. Correct.
[CUSTOMER][NEUTRAL] OK, does it show if like the 1208 is a covered service? It's the same I mean same thing but a different code for the same thing?
[AGENT][NEUTRAL] Let me look on the fact that.
[AGENT][NEUTRAL] [PII].
[AGENT][NEGATIVE] Is that right? No, that's not. Yes, that's not covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] No, OK, so it's not covered at all. OK, I will make a note of that. Thank you so much.
[AGENT][POSITIVE] Well, you are certainly welcome and the fact that that I've sent to you, um, for the Nikki, it lists all the covered codes under there in each of the categories.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] Well, you are certainly welcome. And again, is there anything else I can help you with?
[CUSTOMER][POSITIVE] No ma'am thank you.
[AGENT][POSITIVE] Well, you're very welcome. And again, thank you for calling APL. Have a wonderful weekend.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you, bye bye.