AccountId: 011433970860
ContactId: 2eb4c00d-1529-4c26-96c4-2acc4530f8cc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 313679 ms
Total Talk Time (AGENT): 157441 ms
Total Talk Time (CUSTOMER): 120465 ms
Interruptions: 3
Overall Sentiment: AGENT=0.8, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/2eb4c00d-1529-4c26-96c4-2acc4530f8cc_20250522T16:33_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, um, I'm calling to get benefit information regarding a patient that's coming into our office right now.
[AGENT][POSITIVE] Sure, I can check benefits for you. Uh, I'm sorry, what was your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you and then do you have that policy number?
[CUSTOMER][NEUTRAL] It is 599963.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And what was the name and date of birth for the member?
[CUSTOMER][NEUTRAL] [PII] date of birth [PII].
[AGENT][NEUTRAL] Um, I've got a different name for the member with that date of birth under this policy.
[CUSTOMER][NEUTRAL] Um, that's her that she goes by [PII] as well.
[AGENT][NEUTRAL] OK, yeah, that's what we got. Alright, I wanted to make sure that was the same person. Alright, appreciate you verifying that, um, so this policy is active effective date was [PII], um, and if you'd like I can send you a fax back that shows all of the covered procedures and benefit information.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh well she's actually in the office because I can I do it over the phone? It'll just be quicker.
[AGENT][NEUTRAL] Sure, yeah, give me just a moment let me get that pulled up.
[AGENT][NEUTRAL] I can still send it if you'd like just for your records but I can definitely answer questions over the phone.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, yeah.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] All righty.
[AGENT][NEUTRAL] Of course I will let you know verification of coverage is not a guarantee of payment for claims. Uh, so in short, um, this calendar does or this policy does operate on a calendar year basis, so it is $1000 max per calendar year with a $50 deductible per covered insured up to $150 per family, and that uh deductible does not apply to exam or pro fees. Um, did you have any specific questions or any specific procedures I needed to look at?
[CUSTOMER][NEUTRAL] Alright
[CUSTOMER][NEUTRAL] Yeah yes, has she used any of our maximum?
[AGENT][NEUTRAL] Let me check. Give me just a moment.
[AGENT][NEUTRAL] OK, no, she has not.
[CUSTOMER][NEUTRAL] OK, and, and OK, so.
[CUSTOMER][NEUTRAL] Alright, and what are the preventative, basic and major percentages?
[AGENT][NEUTRAL] OK, so this policy is a bit different, it's not going to be percentages each specific procedure code has a set benefit amount that it would pay.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK, so can I give you the two codes?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] It's 33, I don't know, it's not 33.
[CUSTOMER][NEUTRAL] Make sure I do my premolar wait.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] I'm having a hard yeah. I can't remember what my case numbers are. OK, yeah, pre-W Waller is D 3320.
[AGENT][NEUTRAL] 3320 OK.
[CUSTOMER][NEUTRAL] And the other code is D2954.
[AGENT][NEUTRAL] 954. OK.
[AGENT][NEUTRAL] Let's see, so 3320.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] A root canal, um, we've got that benefit amount at $247.
[CUSTOMER][NEUTRAL] OK, so that's how much will be you guys are um will pay, OK.
[AGENT][NEUTRAL] We would pay that is that is the benefit amount correct um OK and then 2954.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] That benefit amount is $105.
[CUSTOMER][NEUTRAL] OK, so you said 247 and 105?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, alright, so that's just all you will pay towards the possible and this is still subtracting from the deductible, subtract the deductible.
[AGENT][NEUTRAL] Uh, yes, so yeah, anything, um, outside of cleanings or exams, uh, that deductible would apply.
[CUSTOMER][NEUTRAL] OK, alright, and what say again, what is, what is the type of policy this is I can just write it down. I forgot what you said you said it's paid their set prices for each code. Is that how you said it? OK.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Yes, yes, each, yeah, this is quite a bit of an older policy, um, so each procedure code, um, has a specific dollar amount that would be the maximum benefit.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK, alright, thank you so much that is all I needed.
[AGENT][NEUTRAL] Did you still want me to send this uh fax back to you for your record, [PII]?
[CUSTOMER][NEUTRAL] Yes, yes, ma'am.
[AGENT][NEUTRAL] Sure, what was that fax number for you?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I'm gonna read that back to make sure I heard that correctly. That was [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Got it. OK, I will send that now. Should get it within about 10 minutes or so. What did you have any other questions for me at the moment?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No ma'am, that is all you helped me thank you.
[AGENT][POSITIVE] Alright, yeah, of course, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too.
[AGENT][POSITIVE] Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Oh wait