AccountId: 011433970860
ContactId: 60d5a0a1-bb31-46c4-a779-bdf105a3eeb9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 288100 ms
Total Talk Time (AGENT): 149855 ms
Total Talk Time (CUSTOMER): 103871 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/18/60d5a0a1-bb31-46c4-a779-bdf105a3eeb9_20250218T21:20_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. My name is [PII]. I'm calling from the provider's office. I wanted to confirm what kind of insurance this is. Um, the patient just provided this to me and told me that this is now their primary insurance. I just wanted to confirm if this is dental, if it's medical, if it's a PPO.
[AGENT][NEUTRAL] OK, so you're needing to verify eligibility for this number?
[CUSTOMER][NEUTRAL] Full breakdown.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, yes ma'am. I can help you with that. And what is your callback number, [PII]?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] I have 02566816.
[AGENT][POSITIVE] Thank you, one moment please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Maybe I'll leave some weight.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And any information that I provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] His name is [PII]. His date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. Now, what type of benefit information are you needing for him? This is a dental policy that you provided for me.
[CUSTOMER][NEUTRAL] Yeah, uh, I just want the dental benefits and what kind of fees.
[AGENT][NEUTRAL] OK, so we have
[AGENT][NEUTRAL] Yes, and we have a fax back of the member's benefits that I will send to you that has everything on there. Anything not on the fax back means it would not be covered under his plan. He is a subscriber on this policy, and [PII], this policy is active as of [PII].
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK, is there a missing tooth cloth, any waiting periods?
[AGENT][NEUTRAL] There is. Yes, there are, and that information is also on the fax bag. There's a twelve-month waiting period for major endoontic periodontic prosthodontic repair and oral surgery.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And again, all of that information is on the fact that.
[AGENT][NEGATIVE] With this calendar, your max and deductible and then any code not on the fax that means it would not be covered.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK, so would you be able to provide if there's a missing tooth cloth if you pay onto your prep or do I have to wait for the fax?
[AGENT][NEUTRAL] I, I explained that there is a missing tooth cloth and it pays on seats.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, um, are you ready for the fax number?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. Will I need to have your attention on there or is that not necessary?
[CUSTOMER][NEGATIVE] No, that's unnecessary.
[AGENT][NEUTRAL] OK, all right. So give me just one moment, please.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Are you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] OK, and again, your fax number was [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes, that is.
[AGENT][POSITIVE] OK, well, I have just sent that to you so provided there's not any type of technical glitch, you should be receiving that very shortly.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Well, you are certainly very welcome and then once if you all do end up filing a claim with us there, um, [PII], once the claim has been processed with APL.
[AGENT][NEUTRAL] We do have a portal in which you should be able to check claim status and have access to our explanation of benefits, and our portal website is located at [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so that is [PII].
[AGENT][POSITIVE] Yes, but secure, it's secured with a D on it.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] Secured, OK, and this is where we would find the claims and all that info. OK, so claims at the portal, alright.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] You could check claim. You should be able to check claim status and have access to the explanation of benefits once we have processed the claim.
[CUSTOMER][POSITIVE] So claims and ELBs alright perfect.
[AGENT][NEUTRAL] Mhm. OK. And is there anything else that I can help you with this afternoon?
[CUSTOMER][NEUTRAL] Uh, no, if there's a reference number that I can have and that'll be all.
[AGENT][NEUTRAL] You would use my name that I gave you along with today's date.
[CUSTOMER][POSITIVE] Alright thank you so much.
[AGENT][POSITIVE] OK. Well, you're welcome and thank you for calling APL. I hope you have a nice evening.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Thank you. Bye