AccountId: 011433970860
ContactId: 46f0ea43-1829-48bd-b28a-8417723adc90
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 367480 ms
Total Talk Time (AGENT): 135735 ms
Total Talk Time (CUSTOMER): 106033 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/46f0ea43-1829-48bd-b28a-8417723adc90_20250224T21:35_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] Um, yes, I'm calling to get benefits for a patient.
[AGENT][NEUTRAL] OK. Do you need eligibility also or just benefit information?
[CUSTOMER][NEUTRAL] Yeah, eligibility and benefits.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And who am I speaking with?
[CUSTOMER][NEUTRAL] This is [PII]. Um, do you mind holding for like just like 2 seconds?
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] Are you talking to me, [PII]?
[CUSTOMER][POSITIVE] Yes, if you don't mind.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Extraction.
[CUSTOMER][NEUTRAL] The account that you would be doing that.
[CUSTOMER][NEUTRAL] So are we like.
[CUSTOMER][NEUTRAL] I guess we need to rider to the side and uh.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] We don't have anything before then.
[CUSTOMER][NEUTRAL] Is she hurting?
[CUSTOMER][NEUTRAL] OK, I mean,
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] We could probably
[CUSTOMER][NEUTRAL] Do like [PII] on Thursday or [PII].
[CUSTOMER][NEUTRAL] or [PII] here or she can wait until then, yeah.
[CUSTOMER][NEUTRAL] So [PII] Wednesday or Thursday.
[CUSTOMER][POSITIVE] OK, um, I'm so sorry about that.
[AGENT][NEUTRAL] That's OK. All right, [PII], what is your callback number?
[CUSTOMER][POSITIVE] Absolutely
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you and the member's policy number?
[CUSTOMER][NEUTRAL] 02330418
[AGENT][NEUTRAL] OK, thank you. One moment please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and any information, [PII] that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And [PII], is this for a dental policy?
[CUSTOMER][NEUTRAL] Yes, dental.
[AGENT][NEUTRAL] OK, so he is a subscriber on this policy. It is active with an effective date of [PII].
[AGENT][POSITIVE] And we have fax backs of the benefits that I'll be happy to send to you that has everything on it and anything not on the fax back means it would not be covered by his plan.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Are we in, could you tell me if we're in network?
[AGENT][NEUTRAL] This is not a network plan that may choose any provider. Covered services are based on a percentage of the UCR of the service region.
[CUSTOMER][NEUTRAL] OK, um, let me see.
[CUSTOMER][NEUTRAL] And then what is y'all's payer ID?
[AGENT][NEUTRAL] The 60801 and that is also included 2 KC on the back side.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, do you need the fax number?
[AGENT][POSITIVE] Yes ma'am, please.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and does it need to be put to your attention or is that not necessary?
[CUSTOMER][NEUTRAL] Uh, it's not necessary.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Could you tell me um if he has any like preventative history of X-rays or exams?
[AGENT][NEUTRAL] So I can check each code if you'll wait just a second and let me get this fax sent to you.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You can give me the codes that you want checked and I can check those.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, so actually there is no history on file for him.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, and the fax back will have the deductible maximum.
[AGENT][NEUTRAL] Uh-huh. It does have claims mailing address, payer ID, fax number, and then, you know, all of the benefits.
[CUSTOMER][NEUTRAL] And all the
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. And that has been sent so farring there's no technical mishap, you should be receiving that in just a few minutes. And another thing, [PII], is if you all submit a claim to APL once it's been processed, we do have a portal that you should also be able to check our claim status in and have access to our EOB and the portal website for that is secured. [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] They
[CUSTOMER][POSITIVE] OK, got it right.
[AGENT][NEUTRAL] OK. Well, is there anything else that I can help you with today?
[CUSTOMER][NEUTRAL] No, ma'am, that's all.
[AGENT][POSITIVE] OK, well then thank you very much for calling APL and I hope that you have a great rest of your day.
[CUSTOMER][POSITIVE] All right thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Bye-bye.