AccountId: 011433970860
ContactId: 2a6000c5-f310-48d1-aefd-c9cbb3f60b73
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 282679 ms
Total Talk Time (AGENT): 126939 ms
Total Talk Time (CUSTOMER): 73226 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/2a6000c5-f310-48d1-aefd-c9cbb3f60b73_20250130T19:05_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] My name is [PII]. I have a few questions about a patient.
[AGENT][NEUTRAL] You have ques what type of questions do you have? Are you referring to benefits or claims or?
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] Hello.
[CUSTOMER][POSITIVE] Uh, I have benefit questions.
[AGENT][NEUTRAL] OK, and are you calling from a provider's office?
[CUSTOMER][NEUTRAL] I am.
[AGENT][NEUTRAL] OK, and what is your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] Thank you, and [PII], your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] What were the last 4 numbers?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. So I can help you with questions regarding, you said you're needing benefit information, [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, and I can help you. What is the member's policy number?
[CUSTOMER][NEUTRAL] It's gonna be 017.
[CUSTOMER][NEUTRAL] 80611.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] And what type of policy are you calling on [PII]?
[CUSTOMER][NEUTRAL] Uh, dental.
[AGENT][NEUTRAL] OK, so for our dental policy, [PII], we have fax facts of the benefits for the member's plan, and I'll be happy once we verify some things to send you over the fax facts. First off, any information that I do provide for you 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] It's gonna be [PII] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] I do show that he is a subscriber on this policy, [PII], and it is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Can I have the group name or group number?
[AGENT][NEUTRAL] Group number is 13611.
[AGENT][NEUTRAL] Group name in our system is Universal Trucking CC.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And have you already, oh, you've already received the fax on him?
[CUSTOMER][NEUTRAL] I have, I just needed to verify a few things, um, his maximum is 1500, correct?
[AGENT][NEUTRAL] Yeah, sure.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Alright, and no waiting period and I'm missing two calls does apply.
[AGENT][NEUTRAL] There is a missing tooth cloth on this policy. There are specific waiting periods which are listed on that fax back, but all of those have been satisfied based on his effective date.
[CUSTOMER][NEUTRAL] And it's [PII] for coinsurance.
[AGENT][NEUTRAL] Yes, as stated, yes, on that fax back, yes. Preventative are 100% of UCR and the other ones are a breakdown of 80 and 40%, yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can you tell me if he has any history on file that affects herency?
[AGENT][NEUTRAL] I would need for you to provide the codes that you would like for me to check.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Can I have his.
[CUSTOMER][NEUTRAL] So I guess he doesn't have any history for um.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] Do you have any history for tooth number 9 at all?
[AGENT][NEUTRAL] There is no history on file for 29.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I have his last letter of service for an FMX of 022.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] Did you say 0210?
[CUSTOMER][NEUTRAL] Yes, so our panel is 0330.
[AGENT][NEUTRAL] Just a moment. I have to do them one at a time, [PII]. I mean, yes.
[AGENT][NEUTRAL] So 02 10, there is no history.
[AGENT][NEUTRAL] And 03305-17 of 2022.
[CUSTOMER][NEUTRAL] 5:17.
[CUSTOMER][NEUTRAL] I can, um, I have a reference number.
[AGENT][NEUTRAL] Sure. You would use my name that I gave you along with today's date.
[CUSTOMER][NEUTRAL] And your name again? I'm sorry.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][POSITIVE] You are certainly very welcome. Is there anything else that I can help you with today, [PII]?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] OK, well then thank you for calling APL.