AccountId: 011433970860
ContactId: 55457237-8a47-411f-a2a9-52cc34c8521c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 444920 ms
Total Talk Time (AGENT): 195498 ms
Total Talk Time (CUSTOMER): 196794 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/21/55457237-8a47-411f-a2a9-52cc34c8521c_20250521T13:36_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, so, this is [PII] and I'm calling from Dental Med Associates. And the reason I'm calling is because I wanted to know if a patient has coverage for a CT scan here in our office. This is going to be, I believe, the secondary insurance plan.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, I can check on that for you. And um may I have, I'm sorry, I didn't quite catch your name. Can you repeat your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII], OK, thank you. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, the patient's policy number is.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] What, uh, I'm seeing here insured coverage group number, effective date, plan, and hospital benefits cert number. Is that it?
[AGENT][NEUTRAL] That's it, mhm, yes.
[CUSTOMER][NEUTRAL] OK, so 025111.
[CUSTOMER][NEUTRAL] 39 M as in Mary L as in Lion 7
[AGENT][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] May I have the name and?
[CUSTOMER][NEUTRAL] And then if you can, can you verify?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm sorry.
[AGENT][NEUTRAL] No, go ahead.
[CUSTOMER][NEUTRAL] The name of the patient? No, I just wanted to say it's says in hospital benefits number and I just wanna make sure that you know we are in network because there's another one for outpatient it says. I don't know what the what I should give you.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Um, it's fine. It's the same number in the beginning and that's all we need, the numbers in the beginning. Um, let's see, so, yeah, may I have the name and date of birth of the patient?
[CUSTOMER][POSITIVE] Oh awesome.
[CUSTOMER][NEUTRAL] Yes, the patient's name is [PII], and date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and this is not a guarantee of payment, just a verification of coverage and you said you needed benefits. This particular policy is a secondary supplemental plan to the major medical.
[AGENT][NEUTRAL] OK, so this is not the primary, so authorization is not required and network is not um we don't have any networks, OK? We follow primary.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, and let me go ahead and see, and you said the CT is gonna take place in the office. Before I give you any benefits, I need to let you know that this is not a guarantee of payment, just a verification of coverage.
[AGENT][NEUTRAL] OK, we do cover office treatment. This is subject to the outpatient maximum which is 750 per day.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, $750 is the outpatient maximum daily maximum.
[AGENT][NEGATIVE] Incorrect.
[CUSTOMER][NEUTRAL] Right.
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, and then, um, so is it covered?
[CUSTOMER][NEUTRAL] Right, so it is because the the the cost is $350.
[AGENT][NEUTRAL] Um, it
[AGENT][NEUTRAL] It is, um, again, we do cover the office treatments. They have an office treatment rider which is subject to that outpatient maximum benefit. Now, we are just a secondary, so it needs to be approved by the major medical and applied towards the deductible co-payment and co-insurance for us to consider.
[CUSTOMER][NEUTRAL] OK, and can you fax that to me that information?
[AGENT][NEUTRAL] Um, no, we don't fax um for secondary benefits we don't have a fax that we can send over.
[CUSTOMER][NEUTRAL] Oh, it's OK. So I just need to write everything down so I so I can repeat this to the patient. This is a secondary supplemental plan. $750 is the outpatient daily maximum, and in order for there to be coverage.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Uh, we need the primary insurance.
[CUSTOMER][NEUTRAL] What?
[AGENT][NEUTRAL] To apply towards the deductible co-payment and co-insurance and for us to pay they need to pay, we're just a secondary.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] We follow them.
[CUSTOMER][NEUTRAL] OK, we need a primary insurance to pay the deductible.
[AGENT][NEUTRAL] Apply towards the deductible co-payment or co-insurance.
[CUSTOMER][NEUTRAL] To apply the deductible.
[CUSTOMER][NEUTRAL] OK, I'm sorry. I'm gonna say this one more time. And in order for there to be covered, we need the primary insurance to apply the deductible and co-insurance payments.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Apply, yeah, apply towards the deductible, co-payment and co-insurance. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much for that then. That's all I needed.
[AGENT][NEUTRAL] OK, is there anything else I may help you with today? Any other information or any other questions?
[CUSTOMER][NEUTRAL] Uh, no, so even if like I, I, I can still try to submit to you if, um, what, whatever in the whatever treatment the patient gets done today and then I submit to the primary insurance once I get the EOB of that I can submit to you, right?
[AGENT][NEUTRAL] That's correct, yes, that's how it's gonna work. Mhm. And, and I have another question, uh, in the beginning, the name you gave me for the company, um, this is gonna be um a CT scan for, um, for what, what, what type of CT scan? I'm sorry.
[CUSTOMER][NEUTRAL] So he's gonna get a CT scan so the oral surgeon can take a look at his teeth and see if um the wisdom teeth are like connected or close to the nervous system, I guess, I'm not sure, to determine what type of oral surgery he's gonna get. That's the reason he needs a CT scan.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] OK. So the CT scan is, is not for a sickness. It's basically to, to do a surgery on the tooth or is it due to a sickness?
[CUSTOMER][NEUTRAL] Yes. This is to treat um an extraction, yeah, for his wisdom teeth.
[AGENT][NEUTRAL] It's the two things.
[AGENT][NEUTRAL] Um, that's not really sickness and the benefits of the policy, um.
[AGENT][NEUTRAL] Yeah, if it's for teeth, um, the
[CUSTOMER][NEUTRAL] So the policy is to treat sicknesses.
[AGENT][NEUTRAL] Yeah, this is for sickness or accidents, um, it doesn't cover dental.
[CUSTOMER][NEUTRAL] Sicknesses and accidents, it doesn't cover dental.
[AGENT][NEUTRAL] Mhm. Yeah.
[CUSTOMER][NEUTRAL] OK, thank you for that that clarified everything, so there's no reason for me to submit to the secondary insurance.
[AGENT][NEUTRAL] OK
[AGENT][NEUTRAL] No, it doesn't look like no. Yeah, I was, I, I look at the name now and I'm like, well, she said dental. Oh OK, yes, I'm so sorry.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK, thank you so much for that clarification.
[AGENT][POSITIVE] You're welcome and thank you for calling ATL. I'm sorry for any inconvenience. You as well, Miss [PII].
[CUSTOMER][POSITIVE] OK, well, you have a great day.
[CUSTOMER][POSITIVE] Thank you. Bye.
[AGENT][POSITIVE] You're welcome. Bye bye.