AccountId: 011433970860
ContactId: 5870d86f-d4be-44e5-ac07-a8e26deec9c4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 221139 ms
Total Talk Time (AGENT): 80068 ms
Total Talk Time (CUSTOMER): 114648 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/11/5870d86f-d4be-44e5-ac07-a8e26deec9c4_20250211T16:10_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] Yes, I recently received a uh benefit information for a patient and I'm needing to find out if it's um what the this if this is what the policy is gonna pay or this is what the um patient will be paying.
[AGENT][NEUTRAL] OK, you said you want to know if the
[AGENT][NEUTRAL] balance that you see is going to the patient or what they have to pay?
[CUSTOMER][NEUTRAL] OK, I got a breakdown on what you know it it involves for the patient, OK, the calendar year max, 1000, all that good stuff, and then there's a schedule cover dental services and procedures on that benefit amount. Is that the the patient's portion or if it's gonna be the insurance portion they're paying? You you guys are paying for them?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That would be the insurance portion towards whatever is being claimed.
[CUSTOMER][NEUTRAL] OK, so let's say the periodic exam is gonna be y'all gonna be paying $15 is that right? I mean just for say, it would say $15 out of let's say $89 is that right?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] But um I can
[CUSTOMER][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] I can pull up their benefits to see what they have.
[CUSTOMER][NEUTRAL] Sure thing.
[AGENT][NEUTRAL] OK, and may I have your name and a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. My name is [PII]. Phone number [PII].
[AGENT][NEUTRAL] OK, and [PII], may I have the member's policy number?
[CUSTOMER][NEUTRAL] Sure. 00617340.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] [PII], um, let me go back to the account [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. Hold on one moment, let me see what type of policy they have.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, I do have you, um, down on the.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] I'm just waiting for it to come up. Hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, so yes, the calendar year max is how much we'll pay for the year and then those dollar amounts next to the codes are what's applied for whatever code you're billing.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] Right, but is that the insurance portion or is that the, the insured portion?
[AGENT][NEUTRAL] This is the insurance portion. This is what we'll pay towards that code on the claim.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so you, you guys, that's that $15 that you would pay towards the $89 per se.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Is that correct? OK, so that's insurance. OK, that's what I needed to know. And um what's the, uh, do you know the schedule uh fee, the fee schedule for this plan?
[AGENT][NEUTRAL] Well, this one isn't on a fee schedule, it's just the benefit amount for the code.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][POSITIVE] OK. Alrighty. Alrighty, ma'am. Thank you so much. That's what I needed.
[AGENT][NEUTRAL] You're welcome, [PII]. And again, all the information provided was a verification of benefits, not a guarantee of payment. And thanks so much for calling APL. Was there anything else I can help with?
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No, ma'am, thank you so much have a good day bye bye.
[AGENT][NEUTRAL] You too. Bye bye.