AccountId: 011433970860
ContactId: 4220ae56-ba1e-4af7-9b9e-e18ee0c4ce0d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 269709 ms
Total Talk Time (AGENT): 88611 ms
Total Talk Time (CUSTOMER): 116923 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/4220ae56-ba1e-4af7-9b9e-e18ee0c4ce0d_20250206T16:38_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh, yes, hi, this is [PII]. I'm calling from Diamond Bar Smiles. Uh, I have a patient here. I tried to verify her insurance policy. Can you, um, give me, can you go dig into her, um, uh, policy, and we can go over some details.
[AGENT][NEUTRAL] May I have the policy number, please?
[CUSTOMER][NEUTRAL] Sure, the policy number is 60753607536.
[AGENT][NEUTRAL] 607-536
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Sure. Her first name is [PII] and last name is [PII]. And then her birthday is [PII].
[AGENT][POSITIVE] I'm pulling that up for you now.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] So I do have that member's benefits pulled up. How may I assist you?
[CUSTOMER][NEUTRAL] Uh, at first, can I, may I know what type of insurance is TMO or PPO insurance?
[AGENT][NEUTRAL] This is not considered a HMO or PPO. It is based off of this member's contract that they have with us.
[CUSTOMER][NEUTRAL] Oh, I see. So is there annual maximum that she can spend on her treatment?
[AGENT][NEUTRAL] So for this member verification of coverage does not guarantee the payment of the claim.
[AGENT][NEUTRAL] For the calendar year, they have up to $8000 per covered insurance and then they do have a $50 deductible, but that deductible does not apply to.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Exams or prophylaxis.
[CUSTOMER][NEUTRAL] I got it. OK, so it's not applied to preventive and diagnostic.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] 0%. What about her basic like the basic and major?
[AGENT][NEUTRAL] Would you like a fax back to?
[AGENT][NEUTRAL] Disclose all of it.
[CUSTOMER][NEUTRAL] That'll be great. And before I let you go, um, do you know, let's see what else I need. I need a few things. Um, do you know if the
[CUSTOMER][NEUTRAL] I see, uh, how soon can you fax it then?
[CUSTOMER][NEUTRAL] Because I need to plug it in patients here.
[AGENT][NEUTRAL] I can submit it as soon as I um get off the phone. I can submit the request.
[CUSTOMER][NEUTRAL] And by any chance, do you know, can you find out if we are in network for her insurance?
[AGENT][NEUTRAL] This is not considered an in or out of network policy.
[CUSTOMER][POSITIVE] So she can use anywhere she wants.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and do you know which fee schedule do we attach?
[AGENT][NEUTRAL] Let me look at that for you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It looks like it's not based off of a fee schedule either.
[AGENT][NEUTRAL] I'm pulling that back up.
[CUSTOMER][NEUTRAL] So.
[CUSTOMER][NEUTRAL] I mean we can we can do the UCR, no problem, but I just don't wanna overcharge in patient.
[AGENT][NEUTRAL] Yes, it is showing that you do use the usual and customary rate.
[CUSTOMER][NEUTRAL] Mhm. OK, got it. OK, so uh you have our, uh, fax let me give you my uh my fax number.
[AGENT][NEUTRAL] May I have that, please?
[CUSTOMER][NEUTRAL] Sure [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And may I have a call back number to notate please?
[CUSTOMER][NEUTRAL] Sure, [PII].
[CUSTOMER][NEUTRAL] And very lastly, what's the effective day on this policy?
[AGENT][NEUTRAL] Let me pull that up for you.
[AGENT][NEUTRAL] It is showing that the effective date is [PII].
[CUSTOMER][NEUTRAL] OK, and can I have your first name?
[AGENT][NEUTRAL] Yes, it is [PII], last initial of [PII] and today's date for the call reference.
[CUSTOMER][NEUTRAL] Mhm, do they say? OK.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] Got it. Alright, thank you so much, [PII]. You have a great day. OK, I'll wait for the fax.
[AGENT][POSITIVE] OK, I'll get that over to you and thank you so much for calling American Public Life. Have a great day.
[CUSTOMER][POSITIVE] Thank you bye.
[AGENT][NEUTRAL] OK