AccountId: 011433970860
ContactId: 5ba0a914-e14e-4b3b-88be-ad87393c2eef
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 356660 ms
Total Talk Time (AGENT): 103691 ms
Total Talk Time (CUSTOMER): 169235 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/5ba0a914-e14e-4b3b-88be-ad87393c2eef_20250124T15:05_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, excuse me, lost my voice. Hi [PII], my name is [PII] and I'm calling from a provider's office.
[AGENT][NEUTRAL] That's OK. Hi.
[CUSTOMER][NEUTRAL] And um I just have some questions about a patient's um dental policy. I received a fax of benefits yesterday and I just have some questions about it.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, I can help you with those questions, Ms. [PII], can you give me your callback number just in case the call gets disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Thank you, ma'am. And then what is the patient's name?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK. And what's [PII]'s date of birth?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And her policy number, please?
[CUSTOMER][NEUTRAL] 614-1117.
[AGENT][NEUTRAL] OK, let me pull that policy up real quick.
[AGENT][NEUTRAL] OK. I'm gonna pull up the facts back so I can look at what you're looking at.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I've got it pulled up.
[AGENT][NEUTRAL] How can I help you with the questions that you have about it?
[CUSTOMER][NEUTRAL] OK, so first question is um are you showing us as in network?
[AGENT][POSITIVE] Yes ma'am, she can use any dental or dentist that she'd like to use.
[CUSTOMER][NEUTRAL] OK, and we and we are gonna is this through connection?
[AGENT][NEUTRAL] No ma'am it's through APL.
[CUSTOMER][NEUTRAL] No, but I mean the fee schedule that we're gonna be used, I'm sorry that wasn't that probably didn't.
[AGENT][NEUTRAL] 00, OK, um.
[AGENT][NEUTRAL] The fee schedule is actually um what's on the plan. That's what is paid.
[CUSTOMER][NEUTRAL] Well I well what I mean is that as far as what we are charging the patient.
[CUSTOMER][NEUTRAL] I understand that it pays on a benefit amount per code but um like for us.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] You know I need to know what y'all have us under as far as the fee schedule are we or is it office fees?
[AGENT][NEUTRAL] It's, it's your office fees what you guys decide to pay and then.
[AGENT][NEUTRAL] If you look at the procedure codes, that's what we will pay.
[CUSTOMER][NEUTRAL] And the patient is responsible for the balance.
[AGENT][NEUTRAL] We don't give patient responsibility just because that's determined by the provider.
[CUSTOMER][NEUTRAL] No, no, no, no, no, no, that's, that's what I meant, yes, I mean because.
[CUSTOMER][NEUTRAL] So we we're gonna file a and and I'm sorry I'm, I'm making this confusing but I'm just trying to be prepared for when the patient is here um so.
[AGENT][NEUTRAL] No, it's OK.
[CUSTOMER][NEUTRAL] I understand like when a patient comes in and has a periodic oral evaluation, her benefit that she's gonna get from this policy is $15. Let's just say we charge $30 she's responsible for the $15 OK, um.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] And and is this policy is this exclusive to these listed codes on this fax?
[AGENT][NEUTRAL] Yes ma'am, um, if there's a procedure that needs to be done that's not on.
[CUSTOMER][NEUTRAL] OK, that's what I thought.
[AGENT][NEUTRAL] This plan, then it's not covered procedure.
[CUSTOMER][NEUTRAL] OK, that's what I thought that's what I thought. I just like to be clear on that, um.
[AGENT][NEUTRAL] Yes, ma'am. Yes.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] I'm, I'm not, I've never seen this, this type of pol not, not this type of policy. I have seen this type of policy. I haven't seen one of this from American Public Life. I'm not, is it's retired, um, OK, it's not a Medicare policy though.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It was through her um or through her husband's employer.
[CUSTOMER][NEUTRAL] OK, OK, that's what I thought. I thought it'd be a he is a subscriber. OK, OK.
[AGENT][NEUTRAL] With uh state of [PII].
[CUSTOMER][NEUTRAL] OK, well that's really all I needed. I mean, because if it's code specific that makes it pretty cut and dry as far as you know being able to tell the patient what their portion is gonna be and they don't because we charge office and that they don't get any adjustments there's no allowable amount or anything.
[CUSTOMER][NEUTRAL] It's just paid from a benefit schedule.
[AGENT][NEUTRAL] Right.
[AGENT][POSITIVE] Right, correct.
[CUSTOMER][NEUTRAL] OK, OK, well, uh, that's all I needed to know and what was your name again?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] My name is [PII]
[CUSTOMER][POSITIVE] [PII], that's right alright [PII] well thank you so much I appreciate your help and you have a great day.
[AGENT][POSITIVE] You're welcome, Ms. [PII]. You have a blessed uh weekend. Thanks for calling APL.
[CUSTOMER][POSITIVE] Thank you. Alrighty, bye bye.
[AGENT][NEUTRAL] All right. Bye-bye.