AccountId: 011433970860
ContactId: 39ba8ef5-554d-4791-8105-e2c8837ec4f3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 281929 ms
Total Talk Time (AGENT): 127767 ms
Total Talk Time (CUSTOMER): 106074 ms
Interruptions: 2
Overall Sentiment: AGENT=3.2, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/39ba8ef5-554d-4791-8105-e2c8837ec4f3_20250114T17:41_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling um in regards to a patient. I I just need to know what her coverage is for fillings, and I also want to inquire about getting a fee schedule sent over to us because we don't have anything current.
[AGENT][POSITIVE] OK, yeah, I'd love to help you with that, Ms. [PII], and let's see, so we're gonna get you a fax back and we're gonna check a code for you, right?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Perfect, do you mind if I get a good call back number from you, my friend?
[CUSTOMER][NEUTRAL] Yeah, it's [PII] that's a direct line.
[AGENT][POSITIVE] Wonderful. And what's the policy number?
[CUSTOMER][NEUTRAL] Is 774982.
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] Alright, take just a second.
[AGENT][NEUTRAL] All right. Could you verify for me, pretty please, your patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yep, it's [PII] [PII].
[AGENT][POSITIVE] Perfect, I do see her here it looks like.
[AGENT][POSITIVE] Perfect, let me pull up her um.
[AGENT][NEUTRAL] Her fax back so I can look up that code and everything for you.
[AGENT][NEUTRAL] Alright and then what is the code we're wanting to look at today?
[CUSTOMER][NEUTRAL] So it's, it's mainly for fillings, uh, let me just see, I'll give you one of our restorative, uh, 2391.
[AGENT][NEUTRAL] Alright, I do see that one is a covered service. It has two limitations. Let me check them.
[AGENT][NEUTRAL] Says replacement of existing only in place for only if in place for 24 months and then it's a maximum of 1 each tooth for 24 months.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] It is covered under her basic restorative, so that's gonna be an 80% of UCR um for the coverage amount.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] And as far as.
[CUSTOMER][NEUTRAL] I don't know exactly, you know what.
[CUSTOMER][NEUTRAL] Can you find out what tooth and surface they're doing for Tia? Can you find out what tooth and surface they're doing for Tia?
[CUSTOMER][POSITIVE] I'm so sorry.
[AGENT][NEUTRAL] No, you're OK.
[CUSTOMER][NEUTRAL] Because I just, we don't have, we're trying to figure out copays for a patient who's currently here.
[CUSTOMER][NEUTRAL] And we don't have a fee schedule to go by, so that's why I was like, well, let me find out what the, the tooth code is and or you know what exact number and surface they're doing so I have an exact code because maybe you could tell me what the or did you, does it show fees on your end?
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] It's like a percentage of UCR, so like I can't see the exact dollar amount, but I can tell you I don't see that code being used so at least you're not limiting like she's already had this tooth done and this tooth done.
[CUSTOMER][NEUTRAL] Yeah, oh, OK, so it wouldn't matter. OK, so then the.
[CUSTOMER][NEUTRAL] Right, right, OK, alright, so then that's all I would need to know is just her co-pay percentage, but are you able to, or do you know who I would talk to about getting a fee schedule sent to us?
[AGENT][NEUTRAL] Uh.
[AGENT][POSITIVE] Oh, I can send that out to you yep, I, I've already filled it out so I'm just gonna need to snag your um, your fax information real quick and the spelling of your name just so I don't have it wrong.
[CUSTOMER][POSITIVE] Oh great, oh awesome.
[CUSTOMER][NEUTRAL] OK, yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Yeah, no problem. It's [PII]
[AGENT][POSITIVE] Oh perfect. I had it right and then the fax number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Alright, [PII]?
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Awesome, I'm hitting send on that now for you, Ms. [PII]. Um, it should be there 5 to 15 minutes and then every code covered on that fee schedule is gonna be listed there and if it's not, um, shown on your fax back, it's not a covered procedure.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] It's not a covered service, got you. All right, thank you so much [PII]. I appreciate all your help.
[AGENT][POSITIVE] Perfect.
[AGENT][POSITIVE] Hey, it's my pleasure thank you so much for giving us a call and I hope you have a fabulous day.
[CUSTOMER][POSITIVE] You too take care.
[AGENT][POSITIVE] My pleasure. Thank you. Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.