AccountId: 011433970860
ContactId: 3fb1af34-b5df-425c-b16f-2e6abc1c26b1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 313510 ms
Total Talk Time (AGENT): 114452 ms
Total Talk Time (CUSTOMER): 140404 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/3fb1af34-b5df-425c-b16f-2e6abc1c26b1_20250401T15:05_UTC.wav
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[AGENT][NEUTRAL] For calling ATL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Good morning [PII]. My name is [PII]. I'm just calling because I'm trying to verify benefits for the patient and I wanted to know if we are in network with your guys' plan.
[AGENT][POSITIVE] OK, I'll be happy to assist with network information. May I have your first name please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][POSITIVE] [PII] and [PII] if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] The policy number is 02434296.
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] The name is [PII]. The birthday is [PII].
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment, um, so I do show with this particular policy, um, since we don't have a network, we go by UCR.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh how does that work? Do do we bill the patient and then they get reimbursed or or do we get paid from you?
[AGENT][NEUTRAL] No, you would, um, bill us and we would pay you directly.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK perfect and so I will need to get some information then um I need to get the group number, the payer ID, the address.
[AGENT][NEUTRAL] OK, I'm showing that the group number is.
[AGENT][NEUTRAL] 16068.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the group name is Universal Trucking.
[CUSTOMER][NEUTRAL] OK, hold on.
[CUSTOMER][NEUTRAL] Universal trucking.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And our payer ID is 60801.
[CUSTOMER][NEUTRAL] Payer is 60801.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] Perfect thank you.
[AGENT][NEUTRAL] And the mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that's in [PII].
[CUSTOMER][NEUTRAL] The uh
[CUSTOMER][NEUTRAL] He's also not
[AGENT][NEUTRAL] And the zip code is [PII]. Were you also needing a fax back breakdown of the benefits?
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Yeah, that will be great.
[AGENT][NEUTRAL] What's that fax number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] You should receive that fax within the next 10 minutes. Was there anything else I can assist with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, yes, I just wanted to know if, um, do I have do I required to get pre-authorization for any treatment?
[AGENT][NEUTRAL] Um, no, that's not required.
[CUSTOMER][NEUTRAL] Not required, OK, and what is the max and if there is a deductible?
[AGENT][MIXED] OK, maximum benefit is $1500 deductible is $50.
[CUSTOMER][NEUTRAL] $50 and what's the coverage uh percentage?
[AGENT][NEUTRAL] Uh, preventative is covered at 100, basic is covered at 80, and major is covered at 40. However, we do have a waiting period, um, because her effective date was [PII]. Um, she would have to wait till [PII] of this year before she can have major services covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] So 2 years for waiting 1 year sorry.
[CUSTOMER][NEUTRAL] And um is the waiting period applied to everything?
[AGENT][NEUTRAL] No, just major.
[CUSTOMER][NEUTRAL] Mayor, OK.
[CUSTOMER][NEUTRAL] For major, OK, and then would you mind telling me if uh the procedure 4341 is considered major or basic?
[AGENT][NEUTRAL] Um, coding has, um,
[CUSTOMER][NEUTRAL] She's SRP.
[AGENT][NEUTRAL] Coding has to be um faxed over, but.
[AGENT][NEUTRAL] Yeah, if it's just one code, I can look that up. Um, you said 3, what was the code?
[CUSTOMER][POSITIVE] Thank you, 4341.
[AGENT][NEUTRAL] 4341 is covered under uh or excuse me, that's perio and that's considered major.
[CUSTOMER][NEGATIVE] It's Mayor? OK, so you guys won't pay for it.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, OK, not a problem. And then, um, in on the fax, is, is it gonna tell me if like, uh, the procedures that are covered like implants, uh, root canals, stuff like that, could you tell me details on everything that is covered?
[AGENT][NEUTRAL] Yeah, anything
[AGENT][NEGATIVE] Anything that any code that is not listed means it's not covered.
[CUSTOMER][POSITIVE] Perfect. Uh, and the last question, uh, fillings, are they downgraded fillings and crowns, are they downgraded?
[AGENT][NEUTRAL] No, we don't do downgrades.
[CUSTOMER][NEUTRAL] No downgrade.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEGATIVE] And waiting period missing to close.
[AGENT][POSITIVE] Yes, we do have one.
[CUSTOMER][NEUTRAL] Missing too, yes, OK.
[CUSTOMER][POSITIVE] Perfect. Um, I believe that's all I have here. OK, yep, that's all I, I have. Thank you so much for your help, and I'll just wait for the fax.
[AGENT][POSITIVE] Thank you for calling APL you have a good day.
[CUSTOMER][POSITIVE] Thank you too bye bye.
[AGENT][NEUTRAL] Bye-bye.