AccountId: 011433970860
ContactId: 3ddb4c16-6929-4805-9792-88af13995246
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 512020 ms
Total Talk Time (AGENT): 195058 ms
Total Talk Time (CUSTOMER): 151812 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/3ddb4c16-6929-4805-9792-88af13995246_20250212T23:52_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] For calling APL, this is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], good afternoon. My name is [PII]. I'm calling from a provider's office.
[AGENT][POSITIVE] Hey [PII], how can I help today?
[CUSTOMER][NEGATIVE] And I'm tired, yeah, so I'm calling because I had submitted a pre-authorization for um one of our patients and I haven't received anything back.
[AGENT][NEUTRAL] OK, let's take a look. What's the policy number?
[CUSTOMER][NEUTRAL] When I said this.
[CUSTOMER][NEUTRAL] I don't have his. Can you look him up with his social or date of birth?
[AGENT][NEUTRAL] Yeah, I can look it up by social.
[CUSTOMER][NEUTRAL] And the red.
[CUSTOMER][NEUTRAL] Are you ready?
[AGENT][NEUTRAL] Uh-huh, go ahead.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] All right. Thank you, [PII]. Let me take a look here. Bear with me one moment.
[AGENT][NEUTRAL] What is the patient's first and last name, please?
[CUSTOMER][NEUTRAL] I have a [PII].
[AGENT][NEUTRAL] All right. And it was a pre-op for medical or dental?
[CUSTOMER][NEUTRAL] For dental.
[AGENT][NEUTRAL] And then what is his date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Alright, thank you so much. Let me see what I got here.
[AGENT][NEUTRAL] OK, I look, it looks like we have the, the pre-treat one here. Do you want me to, I can fax this to you. Do you have a fax number?
[CUSTOMER][NEUTRAL] Yeah, let me give you our fax number. We haven't, we never received anything back, so he has an appointment next week so that way I can give him the correct information. Our fax number is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Just to confirm [PII], that was [PII]?
[CUSTOMER][NEUTRAL] Correct. And then if we can just double check, um, his maximum you guys said it was only 750, he's still active or no?
[AGENT][NEUTRAL] Uh, so the member plan is still active. Uh, the effective date is [PII]. Let me double check and see what the.
[AGENT][NEUTRAL] Uh, annual is on this plan. One second.
[CUSTOMER][NEUTRAL] Yeah, cause I think I sent this out last year.
[AGENT][NEUTRAL] Yeah, OK, cause, yeah, the pre-treat has a different, it says that the plan your maximum is 500, but I'm gonna just make sure.
[CUSTOMER][NEUTRAL] 500, I had 750.
[AGENT][NEUTRAL] Yeah, so it looks like the member's plan, the allowed amount for the year is actually $500 per covered insured with a $50 deductible.
[AGENT][NEUTRAL] And they still have the full 500 left.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][POSITIVE] 500 for dental, my goodness.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Wow.
[CUSTOMER][NEUTRAL] Is this something that the employer pro um provides or can they upgrade their plan?
[AGENT][NEUTRAL] Um, so it is something, let me see, yeah, it looks like it is something that they have through their group, um, as far as they would need to check with their employer to see if they're offering any other plans.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, so you're saying it's 500 because the thing that I have here said 750.
[AGENT][NEUTRAL] Because
[AGENT][NEUTRAL] Yeah, I know this. Did you get a fax back from us?
[CUSTOMER][NEUTRAL] Um, I had called and spoke to somebody, got a full breakdown actually. Let me, um, see if I can.
[AGENT][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Do you have the information there for Dustinors.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Yeah, cause
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] The patient's plan is real.
[CUSTOMER][NEUTRAL] Yeah, it says uh 7:50.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] $50 deductible and actually spoke to somebody or actually you know what it's, it does, I do actually have a fax as well. The fax uh says calendar year maximum $750 per covered insured, calendar your deductible $50 per covered insured up to $150 per family.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um
[CUSTOMER][NEUTRAL] And then it said preventative services 100 radiographs, basic expenses basic restorative is 80%.
[AGENT][NEUTRAL] So yeah, there's a high end and then there's a low, and the patient has the low, which is the 500. The one that you got with the 750 is the high. So,
[AGENT][NEGATIVE] Everything is the same on the fax backs except for the maximum, and I apologize, [PII], that's not the right amount.
[AGENT][POSITIVE] 500 is the correct amount.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] Alright, I'll cross this ball.
[CUSTOMER][NEUTRAL] Yeah, he needs to talk to his HR.
[AGENT][NEUTRAL] Yeah, and the, um, that Max is also on this pre-treat that I just sent over via fax also, so it'll be on there.
[CUSTOMER][POSITIVE] Can even have
[CUSTOMER][NEUTRAL] Are you, can you send me a new fax then that has the correct amount because yeah this one that I have like I said it's a 7:15 and it doesn't say if it's low or high.
[AGENT][NEUTRAL] Yeah, I mean.
[CUSTOMER][NEUTRAL] Oh, actually it does say AM high on the corner left.
[AGENT][NEGATIVE] Yeah, that's not the right one. Yeah, I can I can send you a correct a correct one, excuse me.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] so
[AGENT][NEUTRAL] Yeah, I mean, he may be able to switch over to the high with a um.
[AGENT][NEUTRAL] Hire [PII] if his employer will allow him to switch the plan.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The pre-treat is on its way to you now and then I am um sending the fax back with the uh corrected information on that [PII], OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect, thank you, yeah, because I was quoting him off of the [PII].
[AGENT][NEUTRAL] I know. I'm sorry. Um.
[AGENT][NEUTRAL] OK, so the pre-treat's already been sent and then I just sent the uh the fax back, so.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Did you need anything else from us tonight?
[CUSTOMER][POSITIVE] Exactly right?
[CUSTOMER][NEUTRAL] Um, nope, I think that's it.
[CUSTOMER][NEUTRAL] I'll just wait for that to come through.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, sounds good well we appreciate you calling. I hope you have a nice night.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][POSITIVE] Of course you too bye bye.
[AGENT][NEUTRAL] Bye bye.