AccountId: 011433970860
ContactId: 60ccf06c-2092-4101-a1b7-97de7ce0c5e7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 697130 ms
Total Talk Time (AGENT): 221596 ms
Total Talk Time (CUSTOMER): 144324 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/60ccf06c-2092-4101-a1b7-97de7ce0c5e7_20250224T16:01_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], this is [PII] calling on behalf of dental office to check on eligibility and benefits for a patient on a recorded line. Could you assist me with that, please?
[AGENT][NEUTRAL] OK, you said your name is [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Ensuring you're needing eligibility and benefit information for a dental policy. Is that also correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, ma'am, I can help you with those things and [PII], for our dental policies, we have fax backs of the member's benefits that I will send to you and anything not on the fax back means it would not be covered under their plan.
[AGENT][NEUTRAL] But first off, what is a good callback number for you?
[CUSTOMER][NEUTRAL] OK, sure.
[CUSTOMER][NEUTRAL] Callback number is [PII].
[AGENT][NEUTRAL] Hello
[AGENT][NEUTRAL] Hello, [PII], can you hear me?
[CUSTOMER][NEUTRAL] Yes, I can hear you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] What was your callback number?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yes, that's [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number, please?
[CUSTOMER][NEUTRAL] 969926
[AGENT][NEUTRAL] I'm sorry, [PII], your voice is cutting out. Can you say that again?
[CUSTOMER][NEUTRAL] Yes, so sorry about that. It's 969-926.
[AGENT][POSITIVE] Thank you one moment please.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] OK, just one moment please, [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, sharing any information that I do provide for you will be a verification of benefits and not a guarantee of payment. What is your patient's name, please, and their date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, so I do show that [PII] is the subscriber on this dental policy and it is active with an effective date of [PII].
[AGENT][NEUTRAL] Give me one moment to get her benefit information pulled up.
[CUSTOMER][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And if you would please give me a good fax number, [PII], that I can send her benefits to.
[CUSTOMER][NEUTRAL] Yes, sure. That would be [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. And will this need to be put to your attention or is that not necessary?
[CUSTOMER][NEUTRAL] Oh no, that's fine, thank you.
[AGENT][NEUTRAL] OK just one moment.
[AGENT][NEUTRAL] And again, you said that your fax number is [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, so I have just sent that information to you so you should be receiving that within the next few minutes.
[CUSTOMER][POSITIVE] All right. Thank you so much. And uh will, all the benefits, yes.
[AGENT][NEUTRAL] Well, you
[AGENT][NEUTRAL] Go ahead, I'm so yeah, go ahead with your question.
[CUSTOMER][NEUTRAL] Go.
[AGENT][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Alright, and in the fax part would I get the used amount, the maximum deductibles, and the histories as well?
[AGENT][NEUTRAL] It has the maximum and it has the calendar year deductible. It does not have history. As of now, there have not been any benefits used for this calendar year. But to check history, you would just need to give me, if you're needing that, to give me the code, and I will have to check them one at a time to provide you the history.
[CUSTOMER][NEUTRAL] Alright, thank you so much and I just want to confirm as well it's the group name it's under transportation and development group number L Lima Alpha 0660.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] OK. Give me that group number again.
[CUSTOMER][NEUTRAL] L Lima, Alpha 0660.
[AGENT][POSITIVE] Yes ma'am, that is correct and it is transportation and development.
[CUSTOMER][NEUTRAL] Thank you. And can I have the fee schedule and the claims mailing address, please?
[AGENT][NEUTRAL] OK, this policy, all of the fees, all of the amount, the benefit amounts are on the fax back that I sent.
[CUSTOMER][NEUTRAL] Oh, all right. OK, sure then. And can you please confirm if the coordination of benefits is standard or no duplicate and if there's any missing tooth class waiting period? Oh.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Standards.
[AGENT][NEUTRAL] Yes
[AGENT][NEGATIVE] And it does have a missing tooth cloth, and that is also stated on the fax back.
[CUSTOMER][NEUTRAL] OK, sure. All right then, let's proceed to the history for this patient, please. Should I provide you the quotes one by one?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK. The first one would be 0120.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, give me just a second, please, here.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, for that code, the last day of service was 8-20-2024.
[CUSTOMER][NEUTRAL] That was 8:20 of 24, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Thank you. The next code would be 0 to 10.
[AGENT][NEUTRAL] No history.
[CUSTOMER][NEUTRAL] 0274.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK. [PII].
[AGENT][NEUTRAL] [PII] [PII].
[CUSTOMER][NEUTRAL] All right. The next code would be [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the next code would be.
[AGENT][NEUTRAL] Oh, give me just one second before we move to the next code. One moment, [PII], please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] OK, I'm ready for the next code.
[CUSTOMER][NEUTRAL] All right. That would be [PII].
[AGENT][NEUTRAL] No history.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] No history.
[CUSTOMER][POSITIVE] Thank you. And the last one went.
[CUSTOMER][NEUTRAL] Last code, it's [PII].
[AGENT][NEUTRAL] Uh, no history.
[CUSTOMER][POSITIVE] Alright, thank you so much, [PII], that would be all for this [PII]tient here.
[AGENT][NEUTRAL] OK, and one last.
[AGENT][NEUTRAL] OK, well, and one last thing, [PII], if you all do file a claim with APL for this member, once the claim has been reviewed and completed and processed by APL, we do have a portal in which you should can check claim status and have access to the explanation of benefits for the review, and our website for our portal is located at secured.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] All right, thank you so much.
[AGENT][POSITIVE] OK. Well, you're very welcome. So is there anything else that I can help you with today?
[CUSTOMER][POSITIVE] Uh, that would be all for today, [PII]. Thank you so much for your patience and your time. I really appreciate your help. Yes.
[AGENT][POSITIVE] OK. Absolutely. Well, you're certainly very welcome. And again, thank you for calling APL. I hope you have a very nice day.
[CUSTOMER][POSITIVE] Yes, you too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.