AccountId: 011433970860
ContactId: 473d96eb-59c5-4f3e-8678-31e38f98c7ad
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 368519 ms
Total Talk Time (AGENT): 113132 ms
Total Talk Time (CUSTOMER): 90679 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/28/473d96eb-59c5-4f3e-8678-31e38f98c7ad_20250428T15:12_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII]. How are you?
[AGENT][POSITIVE] I'm doing well, [PII]. How are you?
[CUSTOMER][POSITIVE] Yes, I'm doing great as well.
[AGENT][NEUTRAL] Alright, and how may I assist you today, [PII]?
[CUSTOMER][NEUTRAL] Oh yes, I'm calling from provider's office. Can you help me with one patient eligibility?
[AGENT][NEUTRAL] Sure. May I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][POSITIVE] Thank you and the member's policy number whenever you're ready.
[CUSTOMER][NEUTRAL] Yes. It's 02546457.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, first name [PII]. Last name [PII], [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment, and I am showing the policy is active. It's been effective since [PII].
[CUSTOMER][NEUTRAL] And the policy is still active?
[AGENT][NEUTRAL] Yes, it's still active.
[CUSTOMER][NEUTRAL] Just a moment.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] OK, sure. Thank you very much. Police is active. Can you help me with your name and reference number?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. And again, my name is [PII], first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] And you
[CUSTOMER][NEUTRAL] Just a moment. Uh, you said it's a calendar plan, correct?
[AGENT][NEUTRAL] Yes, it's calendar year.
[CUSTOMER][NEUTRAL] OK. So can you check if the amount is used from deductibles or maximum?
[AGENT][NEUTRAL] Sure, hold on one moment.
[AGENT][NEUTRAL] Um, so far she has not used any of the deductible or met the deductible or used any of the max.
[CUSTOMER][NEUTRAL] OK. So there is no issue for this patient?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] For previous history, anything for previous. Is there any previous history for this patient?
[AGENT][NEUTRAL] Let
[AGENT][NEUTRAL] We've processed one claim for the patient, um,
[AGENT][NEUTRAL] So 12 for code 01110.
[AGENT][NEUTRAL] 00230
[AGENT][NEUTRAL] 00220
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 00274.
[AGENT][NEUTRAL] 00120.
[AGENT][NEUTRAL] Those all have a data service of [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, 5 codes, correct?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And for
[CUSTOMER][NEUTRAL] Uh, exams. Can you check if all exams share the same frequency?
[AGENT][NEUTRAL] So the or evaluations code 120, 40, 50, and 60 share of the frequency of two or valuations per 12-month period.
[CUSTOMER][NEUTRAL] And for buy drinks?
[CUSTOMER][NEUTRAL] All vitamins share the same frequency?
[AGENT][NEUTRAL] Bright wings is once per 12 month period and
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Um, 027-0272 and 274 all have the same frequency.
[CUSTOMER][NEUTRAL] OK. And uh in this uh policy, there are no major services covered, correct?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Only preventive and basic.
[AGENT][NEUTRAL] And radiographs and FMX.
[CUSTOMER][NEUTRAL] OK, radiographs and FMX. So can you check if periodontal maintenance or
[CUSTOMER][NEUTRAL] SRP are covered or not?
[AGENT][NEUTRAL] They're not major for us includes endodontic, periodontic, prosodontic, and oral surgery, so any of those codes would not be covered by this policy.
[CUSTOMER][POSITIVE] OK, sure. Thank you very much for helping me, uh, [PII]. You may have a wonderful day.
[AGENT][NEUTRAL] You're welcome. Was there anything else I can assist you with today, [PII]?
[CUSTOMER][POSITIVE] Uh, no, no, thank you very much.
[AGENT][POSITIVE] All right, you're welcome. Thanks for calling APL. Bye-bye.