AccountId: 011433970860
ContactId: 3bf7c096-05f6-4722-aaa0-26452978ecea
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 341690 ms
Total Talk Time (AGENT): 105695 ms
Total Talk Time (CUSTOMER): 111723 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/05/3bf7c096-05f6-4722-aaa0-26452978ecea_20250505T14:56_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I'm calling regarding a patient's eligibility.
[AGENT][NEUTRAL] OK, well, I can definitely help you with the eligibility. And [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Uh yes, it is [PII] and it's a direct line.
[AGENT][POSITIVE] Thank you and the policy number whenever you're ready.
[CUSTOMER][NEUTRAL] Yes, it is 02054494.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] It's uh [PII], uh, 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. And I am showing that the policy is active. It's been effective since [PII].
[CUSTOMER][NEUTRAL] OK, and then, um, can you also tell me how much of their annual max they've used?
[AGENT][NEUTRAL] For an outpatient? Oh, I'm sorry, this is dental. Hold on one second.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, so, so far they have not used any of their max or met the deductible for [PII].
[CUSTOMER][NEUTRAL] OK and then um just to confirm um.
[CUSTOMER][NEUTRAL] Are the benefits from [PII] and [PII] the same or has anything changed?
[AGENT][NEUTRAL] Oh, no, they're the same and we haven't had any changes.
[CUSTOMER][NEUTRAL] No changes in the plan. OK, perfect and so uh does the patient have any history?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] For [PII]?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Or any um history that would affect frequency.
[AGENT][NEUTRAL] Do you have any um codes?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] 20,210.
[AGENT][NEUTRAL] Um, [PII] was the last day of service for that code.
[CUSTOMER][NEUTRAL] OK and then.
[CUSTOMER][NEUTRAL] For exams and by wings.
[CUSTOMER][NEUTRAL] Uh, sorry, do you need the code? Uh, it's.
[AGENT][NEUTRAL] Yes, please.
[CUSTOMER][POSITIVE] OK, I'm sorry.
[CUSTOMER][NEUTRAL] Uh, for that one is.
[CUSTOMER][NEUTRAL] 0120.
[AGENT][NEUTRAL] Um, for 00120, um, there's no history on file for that code.
[AGENT][NEUTRAL] 00150 um has [PII], which is also paired with that code.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, what about, uh, the 11:20?
[AGENT][NEUTRAL] 11:20. I don't see any history for that code either.
[CUSTOMER][NEUTRAL] OK, and then one last 1, 0270.
[AGENT][NEUTRAL] Um, for 0270, no history on file for that code either.
[CUSTOMER][POSITIVE] OK perfect thank you so much and then just to confirm um annual max is 1500 correct?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK perfect and then are they covered?
[AGENT][NEUTRAL] Um, let me see.
[AGENT][NEUTRAL] There is no orthodontic treatment on this policy.
[CUSTOMER][NEUTRAL] OK perfect thank you and then are you able to help me with what the fee schedule is?
[AGENT][NEUTRAL] Um, this is just a standard, uh, fee schedule. We operate off of UCR for this policy.
[CUSTOMER][NEUTRAL] UCR OK perfect thank you again and then um sorry, your name is?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] And [PII], do you have a reference number for a call?
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name and today's date, and the first initial to my last name again is [PII].
[CUSTOMER][POSITIVE] OK perfect thank you again so much for your help.
[AGENT][POSITIVE] You're very welcome and thanks for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] Thank you you as well bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.