AccountId: 011433970860
ContactId: 416d89e9-afe4-41dd-baa0-fccc03d2b489
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 301489 ms
Total Talk Time (AGENT): 111760 ms
Total Talk Time (CUSTOMER): 106146 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/416d89e9-afe4-41dd-baa0-fccc03d2b489_20250502T14:32_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Um, yes ma'am, this is [PII] from Doctor [PII]'s office. I'm trying to check on a pre-authorization for a patient.
[AGENT][POSITIVE] OK, uh, let's see. And your name is one more time, I'm so sorry.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. I thought that's what you said. I just finished a call with someone named [PII]. I think that just stuck in my heart.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] And Ms. [PII], what's that um policy number, please?
[CUSTOMER][NEUTRAL] What I have is 716183.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEUTRAL] And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK. And the patient's name, date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, and this is for dental, correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK. Well, I show his effective date is [PII]. He is active on the policy, and we don't have like a pre-cert department, but if you like, if you need benefits, I can send you a fax back.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so he don't have to have a pre-authorization?
[AGENT][NEUTRAL] Uh, no, ma'am, it's not required.
[CUSTOMER][NEUTRAL] OK, OK, because we're doing a bridge, so it's like a $5000 claim, so I just.
[CUSTOMER][NEUTRAL] Um, yeah, if you.
[CUSTOMER][NEUTRAL] If you can tell me like how much do you all cover, I can give you two different codes and you can tell me like how much y'all cover and how much his portion is.
[AGENT][NEUTRAL] OK. Well, I wouldn't be able to give you his portion, but I can definitely verify those codes. Um, what are the codes, please?
[CUSTOMER][NEUTRAL] So the first one is 06240.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the next one is 06750.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the next one is 02950 and that's it.
[AGENT][POSITIVE] OK, thank you, ma'am. Give me one quick moment.
[CUSTOMER][NEUTRAL] Oh sure, my scan it ready to, you know, you get ready to come home and then.
[AGENT][NEUTRAL] See.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] It's no, uh, basically not hooked up to.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] My phone and then I go to Wi Fi and it is no network selected so I clicked on the network thinking I need to select one I need to get your teams working.
[AGENT][NEUTRAL] 6240.
[CUSTOMER][NEUTRAL] Because she's on the.
[AGENT][NEUTRAL] 675.
[AGENT][NEUTRAL] Uh OK.
[AGENT][NEUTRAL] OK. Um, not a guarantee of payment, just verification of coverage for the code 6240 for their policy fee schedule, the max we pay is 335. For the 6750, the max payable is 382, and for the 2950, the max payable is uh 104.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And do y'all cover the is it 50% or what is the percentage?
[AGENT][NEUTRAL] Well, it doesn't pay by UCR it just pays by their policy fee schedule. So on his policy fee schedule, those are the amounts for those codes that we pay.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, because I'm trying to figure out his amount.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK, um, how much remaining benefits does he have for this year because he's already had one crown done.
[AGENT][NEUTRAL] OK, uh let's see.
[AGENT][NEUTRAL] Um, my, my computer is slow.
[AGENT][NEUTRAL] Uh, well, for Mr. [PII], it looks like he has max's benefit for the year.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's what I thought.
[CUSTOMER][NEUTRAL] And he starts over in January?
[AGENT][NEUTRAL] Uh, yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alrighty thank you so much for all your help.
[AGENT][POSITIVE] You are welcome, Miss [PII], and thanks for calling APL. Have a great day and weekend.
[CUSTOMER][POSITIVE] You too thank you bye bye.
[AGENT][NEUTRAL] Mm bye.