AccountId: 011433970860
ContactId: 2b6eca24-13e9-44ef-bcd6-cc030b9e91a6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 684119 ms
Total Talk Time (AGENT): 299368 ms
Total Talk Time (CUSTOMER): 217215 ms
Interruptions: 1
Overall Sentiment: AGENT=0.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/2b6eca24-13e9-44ef-bcd6-cc030b9e91a6_20250206T19:40_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII] I'm calling from Market dental. How are you doing today?
[AGENT][POSITIVE] I'm doing well. How are you?
[CUSTOMER][POSITIVE] Yeah, I'm doing fine. Thank you so much for asking me. I'm here to verify eligibility benefits for the patient. Could you please help me with that one?
[AGENT][POSITIVE] Sure, I'll be more than happy to help you with the eligibility and benefits. And around, may I have a good contact number in case we're disconnected and the member's policy number?
[CUSTOMER][NEUTRAL] Yeah, contact number [PII] and it's a direct line, no extension.
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Oh yes. Uh, patient policy number is 614934.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Patient first and last name, [PII], and the date of birth, [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. I am showing the policy is active. It's been effective since [PII].
[AGENT][NEUTRAL] And did you need a copy of the fax back sent to you or you have particular questions?
[CUSTOMER][NEUTRAL] OK, thank you so much, but I just, um, want to go with some specific questions. Uh, it will just take 22 to 3 minutes. OK, can I go with my questions?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Would you please help me with the deductibles and yearly maximum for this plan?
[AGENT][NEUTRAL] The yearly max is $1000 per covered insured.
[AGENT][NEUTRAL] And the deductible is $50 per covered insured up to $150 per family. It does not apply to exams or pro fees.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] So you said family rate is 2250, right?
[AGENT][NEUTRAL] No, the family deductible is $50 per person up to $150 per family.
[CUSTOMER][NEUTRAL] OK. Could you please help me with the coin insurance percentages for the preventive basic and major?
[AGENT][NEUTRAL] I'm sorry, can you say that slowly, please?
[CUSTOMER][NEUTRAL] OK. Coinsurance percentages for the preventive, basic, and major, please.
[AGENT][NEUTRAL] Um, this policy is not on a schedule like that. It's just a list of codes and then what the dollar amount would be for that code. Um, the facts that show.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] OK, no need for that one. I'll provide you 3 quotes. Just let me know if those 3 quotes are covered or not. I, as I said, it's a specific dollar amount plan, so I'll take 100%.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] I'm ready for the code when you are.
[CUSTOMER][NEUTRAL] 0120
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 2160
[AGENT][NEUTRAL] And the last code?
[CUSTOMER][NEUTRAL] And 2740.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][POSITIVE] Yeah, take your time, please.
[AGENT][NEUTRAL] 00120 pays at $15.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, hold on, 2160 pays at $35.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And hold on one moment.
[AGENT][NEUTRAL] 2740.
[AGENT][NEUTRAL] Um, pays up to $215.
[CUSTOMER][NEUTRAL] Would you please help me with the group number?
[AGENT][NEUTRAL] Mhm. Hold on one moment.
[AGENT][NEUTRAL] Um, there's no group number for this policy.
[CUSTOMER][NEUTRAL] Um, could you please help me with the payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] 60801, right? And uh is there any group name?
[AGENT][NEUTRAL] No, there's no group name for this policy.
[CUSTOMER][NEUTRAL] No group name and the no group number. Can you go ahead, please.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK. And um as per checking here, subscriber name is [PII]. Would you please confirm if this information is correct?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] And you said effective date is [PII]. What about the plan start month? Is it a calendar air plan or be first air plan?
[AGENT][NEUTRAL] Calendar year.
[CUSTOMER][NEUTRAL] Calendar, anything used or met from the deductibles and yearly maximum for this plan?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEGATIVE] Um, so far for [PII], none of the max has been met or the deductible.
[CUSTOMER][NEUTRAL] Um, are they covered benefit here orthodontics?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Orthodontics is a covered benefit here.
[AGENT][NEUTRAL] Uh, let me see if there's orthodontics. Hold on one second.
[AGENT][NEUTRAL] Um, orthodontic is not covered on this policy.
[CUSTOMER][NEUTRAL] Uh, so it's not covered. Is there any history for this patient which can affecting the frequency limitations, please?
[AGENT][NEUTRAL] Um, what codes, we will have to go through the claims to see what codes have history with those codes.
[CUSTOMER][NEUTRAL] OK, I don't have any specific code. Just let me know is there any recent history, please.
[AGENT][NEUTRAL] OK, let me see if I can do that. The last claim we received was [PII] for data service, [PII].
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] [PII]. This is for which service?
[AGENT][NEUTRAL] Data service, um, this is giving claim information, um.
[AGENT][NEUTRAL] The code was 04341.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Data service is [PII].
[CUSTOMER][NEUTRAL] So for the 4341, [PII], right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Uh, you said first school was, uh, first service was [PII]. Uh, so for the date of service.
[CUSTOMER][NEUTRAL] Which services patients have taken.
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Uh, could you please help me with the recent history dates? You said [PII] for one service. I didn't get that service name or code. Could you please help me with that one?
[AGENT][NEUTRAL] This is, this is another claim, so I, that's what I was trying to explain to you. We don't have a place that just has history with a list of codes. It's per the claim that was processed. So the last claim process we received in January and it was for the [PII] date of service.
[CUSTOMER][NEUTRAL] [PII], but you didn't set any [PII] date. You just said for [PII].
[CUSTOMER][NEUTRAL] Could you please double check your information?
[AGENT][NEUTRAL] Ma'am, the date of service is [PII]. The code on this claim is 04341.
[CUSTOMER][NEUTRAL] 04341. OK. Is there any other histories?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] I mean, there is the the patient has been with us since [PII]. Do you have particular codes that you want me to check history on? I can't go through each of the claims.
[CUSTOMER][NEUTRAL] So, I'm looking for the [PII] and [PII] history, please. No need for the [PII] history.
[AGENT][NEUTRAL] OK, so this is what I'm saying to you.
[AGENT][NEUTRAL] There the claims, I will have to go through each claim to see what code is on that claim to be able to give you history. So I'm asking you if you have codes that you're you're wanting to know the history for so that I can search these claims for you. If not, the last claim.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I don't have
[AGENT][NEUTRAL] The last claim process was received [PII] and it was the date of service that I gave [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the code is 04341.
[AGENT][NEUTRAL] That was the last claim process for [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That be that before one?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Before that, do we have any claim recent one?
[AGENT][NEUTRAL] Not for the year of [PII]. These are all [PII].
[CUSTOMER][NEUTRAL] OK, could you please help me with that one?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Then I hope this, so the next um data service that's on here is [PII] and the code used was 07140.
[CUSTOMER][NEUTRAL] OK, that's it.
[CUSTOMER][NEUTRAL] For [PII]?
[AGENT][NEUTRAL] You're wanting me to go through all the claims and let you know what claims from [PII] have been processed?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] I can't do that. What codes are you looking for for history?
[CUSTOMER][NEUTRAL] I don't have any specific codes, ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] There's no way for me to check history without codes, um, unless I go through each claim that has been processed.
[CUSTOMER][NEUTRAL] I'm asking for the [PII] history, ma'am. Could you please help me with the 2024 history for any codes?
[AGENT][NEUTRAL] Do you understand, so what I'm trying to explain, I understand your question. To obtain the answer to your question, I will have to go through each and every claim that was processed. I cannot do that. For your patient and what they're having done, if you do not have a list of codes to check the history, there's no way for me to go through all these claims.
[AGENT][NEUTRAL] To see what's from [PII] and what was used on top of, I'm now giving you.
[AGENT][NEUTRAL] Another provider's claim information.
[CUSTOMER][NEUTRAL] OK, fine, so you can't able to give it, right? Could you please help me with the call reference number?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, what is the name?
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][POSITIVE] OK, thank you, [PII]. Thanks for patience and help. Have a nice day.
[AGENT][NEUTRAL] You also