AccountId: 011433970860
ContactId: 4562d9f0-f671-4260-a660-b5b0adefb792
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 617900 ms
Total Talk Time (AGENT): 185540 ms
Total Talk Time (CUSTOMER): 249020 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/21/4562d9f0-f671-4260-a660-b5b0adefb792_20250221T13:26_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. This is Easy. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is, this is [PII] checking for the dental benefits for the patient.
[AGENT][NEUTRAL] I'm sure, [PII], I can assist you with benefits. Um first, I'll need a good callback number just in case we're disconnected.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Thank you. Now, I need the policy number, please.
[CUSTOMER][NEUTRAL] The policy number is 02274817.
[AGENT][NEUTRAL] Please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] Thank you and just let me advise you that verification of coverage does not guarantee payment of claims. Um, the effective date on this policy was [PII] and the policy is still active.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes sir, what other benefits do you need to verify?
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Oh, can you, uh, check that is is running on a contract basis or currentary basis?
[AGENT][NEUTRAL] Calendar year and we cover up to $500 per calendar year and there's a $50 deductible that needs to be met first.
[CUSTOMER][NEUTRAL] I for the council
[CUSTOMER][NEUTRAL] OK $50 in your restaurant, right? So is there any family restaurant under the plan?
[AGENT][NEUTRAL] Um, no, I'm showing this is the, he's the only member under the plan.
[CUSTOMER][NEUTRAL] OK. And for the maximum of $500 or the deductible of $50 is it anything or no?
[AGENT][NEUTRAL] No, nothing's been met so far this year.
[CUSTOMER][NEUTRAL] Nothing has been used, OK. And ma'am, what is the group name under this plan?
[AGENT][NEUTRAL] OK, the group name is?
[AGENT][NEUTRAL] Partners, P like Paul, A R T N like Nancy, E R S like Sam.
[AGENT][NEUTRAL] Partners, personnel management.
[CUSTOMER][NEUTRAL] your partner's personal management, right?
[AGENT][NEUTRAL] Yes, sir. That's the group name.
[CUSTOMER][NEUTRAL] OK and what is the group number?
[AGENT][NEUTRAL] The group number is 70087.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] And ma'am, uh, for the provider participation, can you please check me that is our provider part in network or out of network on this one.
[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Um, we work with all providers. There's no network.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And also
[CUSTOMER][NEUTRAL] Can you please check that for the coverage percentage or the insurance percentages?
[AGENT][NEUTRAL] Please repeat the question.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] The coinsurance percentages for the diagnostic revenue, basic and medical services.
[AGENT][NEUTRAL] For basic services, we cover up to
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, for basics, we cover up to 80%.
[AGENT][NEUTRAL] And there's no waiting period.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And, and I'm showing for major services, there's no coverage under this policy.
[CUSTOMER][NEUTRAL] No coverage plans. And what about the
[CUSTOMER][NEUTRAL] Uh, oral ended on the oral surgery.
[AGENT][NEUTRAL] What's the code, please?
[CUSTOMER][NEUTRAL] Uh, for the 3330, 4 43 41, and uh 71 0.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] You said 33, 30?
[CUSTOMER][NEUTRAL] Yeah, 3 to 30, yes.
[AGENT][NEUTRAL] OK, I'm not showing that on the fee schedule. Um, what's the other code?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 4341.
[CUSTOMER][NEUTRAL] Then 7210.
[AGENT][NEUTRAL] 43
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I'm not showing those codes either.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] That also not covered under the plan, right?
[AGENT][POSITIVE] Right, that's correct.
[CUSTOMER][NEUTRAL] OK. And for the deductible, is it applied for uh basic services, ma'am, or both the services?
[AGENT][NEUTRAL] Um, it's for all services for the calendar year and it's a $50 deductible.
[CUSTOMER][NEUTRAL] From
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] No no
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] I apologize.
[CUSTOMER][NEUTRAL] Can you get them.
[CUSTOMER][NEUTRAL] OK, ma'am. Uh, there are price only for the basics, right?
[AGENT][NEUTRAL] Right, that's correct. It does not apply to preventative services.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, and the preventive services uh covered at 100% sir.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. And does the maximum applies to preventive services?
[AGENT][POSITIVE] Yes, it does.
[CUSTOMER][NEUTRAL] OK, OK. And what are the waiting period and missing to close under the plan?
[AGENT][NEUTRAL] The waiting period?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm not showing there's a waiting period for the covered services.
[CUSTOMER][NEUTRAL] OK. What are the missing tooth clothes?
[AGENT][NEUTRAL] Yes, there is.
[CUSTOMER][NEUTRAL] That is OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] OK. And uh for the coordination benefits?
[AGENT][NEUTRAL] What type of benefits? I'm sorry?
[CUSTOMER][NEUTRAL] The COB ma'am. COB.
[CUSTOMER][POSITIVE] Yes, now it's better.
[CUSTOMER][POSITIVE] No problem.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Um, I'm not showing any.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] No, see you will be under the plan, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK. And is there any pre-authorization required?
[AGENT][NEUTRAL] No, there isn't.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And also can you please check that uh for the patient, is there any histories on file which might affect the frequency?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] It's really.
[AGENT][NEUTRAL] No, because it's based on the calendar year and I'm not showing any services for this year.
[CUSTOMER][NEUTRAL] Uh, can you please check for the previous years?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, and there isn't any um on file. No, sir.
[CUSTOMER][NEUTRAL] That is OK.
[CUSTOMER][NEUTRAL] And for orthodontics, is there any coverage under the plan?
[AGENT][NEUTRAL] Please repeat the question.
[CUSTOMER][NEUTRAL] Uh, for the orthodontics, is there any coverage?
[AGENT][NEUTRAL] Orthodontics? No, there isn't.
[CUSTOMER][NEUTRAL] No, OK. And I have procedure codes to check. Can you please help me with the percentages and the frequencies for that?
[AGENT][NEUTRAL] For which code?
[CUSTOMER][NEUTRAL] Uh, I have almost.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] 168.
[CUSTOMER][NEUTRAL] 970.
[CUSTOMER][NEUTRAL] Uh, I have a total of 14 quotes with me, 14 procedure codes. Can you please provide me the frequency?
[AGENT][NEUTRAL] I can
[AGENT][NEUTRAL] I can fax you the um the breakdown of benefits.
[CUSTOMER][NEUTRAL] OK, so that will be helpful. So can you please fax me that one?
[AGENT][NEUTRAL] Yes. What's your fax number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]. [PII].
[AGENT][NEUTRAL] OK, so that's attention, [PII], [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. You should receive it in about 10 minutes. I just sent it. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] No, that's all. Thank you. Can you please spell your name and again, uh, also one, ma'am, can you please provide me the insurance for mailing address and the payer ID?
[AGENT][NEUTRAL] Yes, the pair ID is 60801.
[AGENT][NEUTRAL] The mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's in [PII].
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Uh, OK, the code is [PII], right?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK, thank you. And also, yes ma'am, there's some information I needed. Can you please provide me your name and the conference number.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Yes, for the reference number, you can use my name and today's date. My name is [PII]. It's spelled [PII] Last initial is [PII], and today's date.
[CUSTOMER][NEUTRAL] uh
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK. Thank you, [PII] and have a nice day. Bye.
[AGENT][NEUTRAL] You do the same, [PII]. Thank you for calling ATL. Mm bye.