AccountId: 011433970860
ContactId: 3c6bb589-a1c6-438b-82e2-aa513144fe53
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 510029 ms
Total Talk Time (AGENT): 174641 ms
Total Talk Time (CUSTOMER): 197551 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/3c6bb589-a1c6-438b-82e2-aa513144fe53_20250424T17:57_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh yes, I was trying to verify coverage for a patient.
[AGENT][NEUTRAL] OK, sure, I can assist you with the eligibility. May I have your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] You said [PII] or [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Great.
[AGENT][NEUTRAL] [PII], OK, thank you. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Absolutely it is [PII].
[AGENT][NEUTRAL] OK, thank you. And what's the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Children's Dental Center.
[AGENT][NEUTRAL] OK. May I have the patient's policy number?
[CUSTOMER][NEUTRAL] So I do not have a member ID for him. He stated he did not have a card, but I have his social.
[AGENT][NEUTRAL] OK, um, bear with me just a second, let me pull another system for the social.
[AGENT][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] May I have the name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. What's his date of birth?
[CUSTOMER][POSITIVE] Yes please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, perfect. And um so you said you need benefit information today?
[CUSTOMER][NEUTRAL] For dental, yes ma'am.
[AGENT][NEUTRAL] OK, you need this information given to you verbally or faxed over to you?
[CUSTOMER][NEUTRAL] Um, could I possibly get a benefit fax and ask a couple of questions?
[AGENT][NEUTRAL] Yes, mhm, you can. Um, let me go ahead and get that fax number if you don't mind.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] OK, it is [PII].
[AGENT][NEUTRAL] OK, so that is [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] Yeah, right. OK, let me go ahead and pull the benefits really quick.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] For
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] OK here it is.
[CUSTOMER][NEUTRAL] It looks like you had a $6.12 balance.
[AGENT][NEUTRAL] OK. And go ahead with your questions.
[CUSTOMER][NEUTRAL] OK, um, could you possibly tell me his member ID?
[AGENT][NEUTRAL] Oh yes, um.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] The policy number or member ID is 02617343.
[CUSTOMER][NEUTRAL] Yeah, both of
[CUSTOMER][NEUTRAL] And that was 02617343?
[AGENT][POSITIVE] Yes, that is correct. Mhm.
[CUSTOMER][NEUTRAL] OK, yes ma'am, and does he have any out of network coverage?
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Yes, uh, this one doesn't have a network per se.
[AGENT][NEUTRAL] There's no network.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and could you tell me the employer for the plan he had said [PII], is that correct?
[AGENT][NEUTRAL] I can
[CUSTOMER][NEUTRAL] Let me see um.
[AGENT][POSITIVE] MU, yes, that is correct. Mhm.
[CUSTOMER][NEUTRAL] So the employer just listed as MAE.
[AGENT][NEUTRAL] Uh yes, the full name if you need it is management analysis and utilization, but they go by MAU.
[CUSTOMER][NEUTRAL] It was management.
[AGENT][NEUTRAL] Analysis.
[CUSTOMER][NEUTRAL] Analysis.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Utilization.
[CUSTOMER][NEUTRAL] And utilization?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and could you also tell me the maximum and the deductible for this plan?
[AGENT][NEUTRAL] Yes, and this is not a guarantee of payment, just a verification of coverage, and that's just a disclaimer, and we have a calendar year maximum of $500 with the $50 deductible and deductible does not apply to preventatives. Um, this is one of our basic dental policies, um, so this one doesn't have any major service, so endedonics, periodontics, prosthodontic repair, and oral surgeries are not covered.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You said no to extractions as well.
[AGENT][NEUTRAL] We only cover the simple extraction.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and is there any coverage for SRP scaling and repainting, or no, does that fall under major with y'all?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] It sounds like it falls on the major. I can check um what is that code?
[CUSTOMER][NEUTRAL] Yes ma'am it is.
[CUSTOMER][NEUTRAL] Bear with me just one moment, I'm gonna pull it real quick.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] So that you don't know with the from that work.
[CUSTOMER][NEUTRAL] Hm
[CUSTOMER][NEGATIVE] That's not the right code.
[CUSTOMER][NEUTRAL] Do it at the beginning, OK.
[CUSTOMER][NEUTRAL] I know
[CUSTOMER][NEGATIVE] Not the right code neither.
[CUSTOMER][NEUTRAL] But I don't know whether they're gonna change insurance or what that's the reason.
[CUSTOMER][NEUTRAL] So that code is D4341.
[AGENT][NEGATIVE] Oh, OK, you know, that one is not gonna be covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then could you also tell me the uh claims address?
[AGENT][NEUTRAL] Yes, and the address to submit claims is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[CUSTOMER][NEUTRAL] Would you mind repeating that zip code for me?
[AGENT][NEUTRAL] Oh sure, yes. That's [PII].
[CUSTOMER][NEUTRAL] I'll put it on.
[CUSTOMER][NEUTRAL] OK, and it was [PII]?
[AGENT][NEUTRAL] Mhm. In [PII]. Correct.
[CUSTOMER][NEUTRAL] Yes ma'am, and what is that payer ID?
[AGENT][NEUTRAL] The payer ID is 60801.
[CUSTOMER][NEUTRAL] I could do, I mean, you know.
[CUSTOMER][NEUTRAL] Alrighty, let's see.
[CUSTOMER][NEUTRAL] Alright, so I added that
[CUSTOMER][NEUTRAL] And sending in claims, what's the insurance company name that we should use?
[AGENT][NEUTRAL] APL or American Public Life.
[CUSTOMER][NEUTRAL] I've got you down for 12.
[CUSTOMER][NEUTRAL] American Public Life.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, yes ma'am, and that was all the questions I had.
[AGENT][NEUTRAL] OK, now I already sent that fax over to you, so it should be there in a few minutes, OK?
[CUSTOMER][POSITIVE] Alrighty thank you so much.
[AGENT][POSITIVE] You're welcome and thank you for calling APO. You have a good afternoon. Bye-bye, Ms. [PII].
[CUSTOMER][NEUTRAL] You as well bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.