AccountId: 011433970860
ContactId: 55b25e8e-82e4-4a7c-b768-3534f51642c7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 343140 ms
Total Talk Time (AGENT): 156454 ms
Total Talk Time (CUSTOMER): 86890 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/55b25e8e-82e4-4a7c-b768-3534f51642c7_20250123T15:12_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I was calling to verify dental coverage.
[AGENT][NEUTRAL] OK, you're needing to just verify eligibility or do you also need a fax back of benefits?
[CUSTOMER][NEUTRAL] Fact that.
[AGENT][NEUTRAL] Ma'am, I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And uh what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] I'm sorry, what did you say? I couldn't hear you.
[AGENT][NEUTRAL] The member's policy number?
[CUSTOMER][NEUTRAL] OK it is 02582785.
[AGENT][POSITIVE] Thank you, one moment.
[CUSTOMER][NEUTRAL] [PII] are you ordering
[AGENT][NEUTRAL] OK, and any information that I do provide for you today [PII] will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And you said you need his date of birth.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, that is [PII].
[AGENT][NEUTRAL] OK, thank you. So I do show he is the subscriber on this policy and it is active with an effective date of [PII].
[AGENT][NEUTRAL] Give me just a moment while I please.
[CUSTOMER][NEUTRAL] And this is for the dental plan.
[AGENT][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And what is a good fax number for you, [PII], that I can send his benefits to?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And will that have the claims address on there?
[AGENT][NEUTRAL] Yes, ma'am, it does. Uh-huh.
[CUSTOMER][NEUTRAL] Do y'all accept assignment of benefits?
[AGENT][NEUTRAL] Uh, explain what you mean by that as far as assigning them to you.
[CUSTOMER][NEUTRAL] Would you pay to an out of network provider or would you pay to the patient?
[AGENT][NEUTRAL] Whomever files the claim.
[CUSTOMER][NEUTRAL] OK, so you will pay to out of network provider.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] And then I'm sorry, go ahead.
[CUSTOMER][NEUTRAL] I need the coverage for.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] 5 specific codes.
[AGENT][NEUTRAL] OK. So first off, this plan only has preventative and basic coverage.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Our extractions covered under basic.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] What is the code?
[CUSTOMER][NEUTRAL] 7140 and 7210.
[AGENT][NEUTRAL] Let me look on his back side. Give me just one second.
[AGENT][NEUTRAL] 7140 falls under basic.
[AGENT][NEUTRAL] And uh on basic.
[AGENT][NEUTRAL] Um, I mean, there is no waiting period. That is on the plan and the other code you said was [PII] to 10?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEGATIVE] And that is not covered.
[CUSTOMER][NEUTRAL] OK, and that fax will be coming over?
[AGENT][NEUTRAL] And just one second, let me get his information put on there. Just one moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And does it need to be put to your attention or is that not necessary, [PII]?
[CUSTOMER][POSITIVE] No it's not necessary, thank you.
[AGENT][NEUTRAL] OK. OK. Uh-huh, sure. Just one moment.
[AGENT][NEUTRAL] It's loading.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And while I'm waiting on this, once we have processed the claim law, you may already have this information, but if not, we do have a portal in which you should be able to check claim status once it's been processed and also have access to the EOB and our portal website is secured.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What's that like?
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] And I'm just gonna repeat your fax number to make sure I heard you correctly. [PII].
[CUSTOMER][NEUTRAL] Yes ma'am, that's it.
[AGENT][NEUTRAL] Alright, well I have sent that to you and then again anything that is not on the fax side means it would not be covered under the policy.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You are certainly welcome. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] No ma'am that's it.
[AGENT][POSITIVE] OK, well thank you again for calling APL and I hope you have a great day, [PII].
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.