AccountId: 011433970860
ContactId: 4f566702-d9cf-46ad-8138-da17af3a1073
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 341290 ms
Total Talk Time (AGENT): 103525 ms
Total Talk Time (CUSTOMER): 93631 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/4f566702-d9cf-46ad-8138-da17af3a1073_20250324T19:51_UTC.wav
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[CUSTOMER][NEUTRAL] Oh, you know
[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi I was calling to verify my patient has uh benefits here.
[AGENT][NEUTRAL] Um, yes, ma'am. I can assist you with benefits. Um, first, could I get your name and a good callback number?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK. Thank you, [PII]. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] OK, it is 02584631.
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] It's gonna be [PII] and his birthday is [PII].
[AGENT][NEUTRAL] OK, 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. And for a list of benefits and the fee schedule, I can fax that over to you.
[CUSTOMER][POSITIVE] Yes, that would be awesome.
[AGENT][NEUTRAL] And your fax number, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, so that's attention [PII] um [PII]?
[CUSTOMER][NEUTRAL] Yes,
[CUSTOMER][NEGATIVE] Yes, and we're gonna be out of network if that matters.
[AGENT][NEUTRAL] Um, we work with our providers. There isn't a network, so.
[CUSTOMER][POSITIVE] OK awesome.
[AGENT][NEUTRAL] OK. Is there anything else that I can assist you with, [PII]?
[CUSTOMER][NEUTRAL] Yeah, if you wouldn't mind, can you, because he's in my chair right now, uh, briefly tell me what his max and.
[CUSTOMER][NEUTRAL] What his coverage is for Indo and uh crowns.
[AGENT][NEUTRAL] OK. Yes, ma'am. One moment.
[AGENT][NEUTRAL] OK, I'm showing that there's a $500 calendar year maximum with a $50 deductible that needs to be met first.
[AGENT][NEUTRAL] Let's see. Has he made anything towards it?
[AGENT][NEUTRAL] Nothing's been met so far, so he still needs to meet the um $50 deductible and there's a $500 maximum. And then you said endo?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, do you have a code for that?
[CUSTOMER][NEUTRAL] Um, yeah, hold on, let me pull it up for you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's gonna be code D3330.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK. He's limited to one X-ray procedure every five-year period.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that's
[CUSTOMER][NEUTRAL] Is it, um, is the root canals covered at uh basic or major?
[CUSTOMER][NEUTRAL] Um, [PII], Ms. [PII] I have a question for you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and what's the code for the root canal?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] D 3330 yeah.
[AGENT][NEUTRAL] You get
[AGENT][NEUTRAL] OK, that's the same one. OK.
[AGENT][NEUTRAL] It's covered in basic 80% of allowable.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then the crown it's gonna be D 2740.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Bye
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I'm not showing a 2740 on the fee schedule.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Um, so no crowns are covered?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Oh, alright, I will let them know and I'll be waiting on that back so.
[AGENT][POSITIVE] OK, I thank you for calling ATL. You have a great rest of your day. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] You too.
[CUSTOMER][NEUTRAL] That's it.
[AGENT][POSITIVE] OK. Thanks, [PII]. You have a good day. Mm bye.
[CUSTOMER][POSITIVE] Thank you you too bye bye.