AccountId: 011433970860
ContactId: 32540e74-aa84-4a3a-a02f-2bf3326b00c0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 287910 ms
Total Talk Time (AGENT): 83471 ms
Total Talk Time (CUSTOMER): 173017 ms
Interruptions: 1
Overall Sentiment: AGENT=0.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/14/32540e74-aa84-4a3a-a02f-2bf3326b00c0_20250414T15:03_UTC.wav
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[CUSTOMER][POSITIVE] Yeah I like late morning.
[AGENT][NEUTRAL] [PII]. How can I help you?
[CUSTOMER][POSITIVE] Hey [PII], I'll be right with you. How about the [PII] at [PII] OK, OK.
[CUSTOMER][NEUTRAL] I'm sorry, yeah, I'm trying to verify that this uh patient has still has these benefits.
[AGENT][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, and he's because he's coming in. I saw it sent a pre-op, but I think he was in and out of being covered, so I'm not really sure they went through. So, um, we're, I'm a provider's office. Do you need me to give the provider information first? This is for.
[AGENT][NEUTRAL] Uh yeah, can I get your name and provider's office and callback number?
[CUSTOMER][NEUTRAL] Yeah, so, yeah, yeah, my name is [PII] and the tax ID for the provider is [PII]. We're out of network. It's Doctor [PII].
[AGENT][NEUTRAL] And your number?
[CUSTOMER][NEUTRAL] And I call back [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, thank you, [PII]. And do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Yeah, and the patient's policy number and his ID number.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Are the actual policy number group number.
[AGENT][NEUTRAL] Uh, it should be the policy er number, yeah.
[CUSTOMER][NEUTRAL] OK, well I think it's 02552755.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] [PII] and his date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And you're wanting benefits or uh what can I help you with?
[CUSTOMER][NEUTRAL] Uh, it's gonna be 8.
[CUSTOMER][NEUTRAL] Yeah, I want to make sure he's uh covered because he went a period of time with not being covered and also to see if you ever er received a pre-authorization.
[CUSTOMER][NEUTRAL] And if so, if it was approved.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Looks like he is effective [PII]. He is currently active.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And um we don't, this is for a dental policy, correct?
[CUSTOMER][NEUTRAL] Huh.
[CUSTOMER][NEUTRAL] Yeah, I know he doesn't have major coverage, um, but I just, uh, I was guess I was seeing if his filling, I guess his his fillings are covered, but you all base it on a allowed amount, so I think that was the thing. I didn't really know what you allowed for fillings so.
[AGENT][NEUTRAL] Um, let me see if that
[CUSTOMER][NEUTRAL] Um, are you able to give that to me if I give you a code?
[AGENT][NEUTRAL] Uh, I can tell you what, if it's covered, yes, what's the code?
[CUSTOMER][NEUTRAL] Oh, OK, so the code is.
[CUSTOMER][NEUTRAL] Uh, is 0 2335.
[AGENT][NEUTRAL] OK, give me one moment. This is not a guarantee of payment, it's a basic outline.
[CUSTOMER][NEUTRAL] Yeah, I remember being a little longer.
[CUSTOMER][NEUTRAL] And are there, and our
[CUSTOMER][NEUTRAL] Alright, and are there any limitations to that like any kind of policy limitations?
[CUSTOMER][NEUTRAL] For filling.
[AGENT][NEUTRAL] OK, so 2335, is that correct?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, it looks like it pays 80% after a $50 deductible.
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I limitations, what do you mean like downgrades or?
[CUSTOMER][NEUTRAL] And that's
[CUSTOMER][NEUTRAL] Yeah, just any, any kind of limitations to the coverage of fillings.
[AGENT][NEUTRAL] Uh, I don't see anything. It just lists, um, our fillings are paid at 80% after a 50.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, alright.
[CUSTOMER][NEUTRAL] Yeah, and then could you tell if I'm above or below that allowance if I give you an amount uh with that code?
[AGENT][NEUTRAL] Um, yeah, I can try and see if it's in our system.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] What's the amount?
[CUSTOMER][NEUTRAL] OK, it's
[CUSTOMER][NEUTRAL] OK, so, uh, 250, is that above or below?
[CUSTOMER][NEUTRAL] You're like huh.
[AGENT][NEUTRAL] Um, let me see, yeah, I get into that part of the system. Hold on one moment.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] So like you come in an office.
[AGENT][NEUTRAL] What's your zip code?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Yeah, I don't have it listed in our system, so I won't be able to give a dollar amount.
[CUSTOMER][NEUTRAL] OK, so you don't really know what the allowance is for our area?
[AGENT][NEUTRAL] Yeah, I mean, we typically allow 80% of what's reasonable and customary in your region, so that's the allowance is 80% of what's customer.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK alright well thank you so much for that information.
[AGENT][POSITIVE] OK, well, thank you for calling [PII]. I hope you have a good day.
[CUSTOMER][NEUTRAL] You too bye.