AccountId: 011433970860
ContactId: 642d5642-9998-495f-bda3-a867f71bd8ed
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 344820 ms
Total Talk Time (AGENT): 182423 ms
Total Talk Time (CUSTOMER): 83550 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/07/642d5642-9998-495f-bda3-a867f71bd8ed_20250307T13:43_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] And thank you for calling APO. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, good morning. I am calling from a provider's office, and I need to verify dental coverage on a patient and to see if we're in or out of network with this plan.
[AGENT][NEUTRAL] OK, so you're needing to verify eligibility and get benefit information on a dental policy, is that correct?
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yes. Yes, ma'am. Yes, ma'am.
[AGENT][POSITIVE] Yes ma'am, I can help you with that and on our dental policies we have fax backs of the member's benefits that I'll be happy to send to you as well. So first off, who am I speaking with please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] My name is [PII]
[AGENT][NEUTRAL] I'm so sorry. Could you, I wasn't prepared for you to spell it. I wasn't ready for that. So would you mind spelling it again?
[CUSTOMER][NEUTRAL] Sure, it's [PII]
[AGENT][NEUTRAL] [PII]. OK, thank you. And your callback number, please?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And the member's policy number please, Oma?
[CUSTOMER][NEUTRAL] 02589602.
[AGENT][POSITIVE] OK, thank you. So if you'll give me just a couple of moments please to get some information pulled up.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And so any information that is provided would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] It's [PII] [PII].
[AGENT][NEUTRAL] OK, thank you, one moment.
[CUSTOMER][NEUTRAL] But
[AGENT][NEUTRAL] OK, so I do show that she is the spouse of the subscriber on this general policy and it is active Zoma. The effective date on this plan is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And this is not a network plan?
[AGENT][NEUTRAL] Uh, they may choose any provider to go to.
[AGENT][NEUTRAL] The this policy, the covered services um are the benefits it provides benefits for covered services based on a percentage of the UCR of the service region.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So there is not a network and that information is also gonna be on the fact that that I sent to you.
[CUSTOMER][NEUTRAL] OK, now, is it a, does it run on a um calendar plan?
[AGENT][NEUTRAL] Calendar year, it does, yes, ma'am.
[CUSTOMER][NEUTRAL] And then does it have a missing two call waiting periods on the plan?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] It does.
[CUSTOMER][NEUTRAL] Um, and it's gonna be on the, on the fax when you send it to me?
[AGENT][NEUTRAL] Uh-huh. All of that information is on page one, including our address for claims, payer ID, fax number, and then any in any code that is not on this fax back that I sent to you means it is not covered under their plan.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and I'm sorry, you did say that uh the waiting periods and the missing tooth claws it's gonna be on the fax, correct?
[AGENT][NEUTRAL] OK give me just.
[AGENT][NEUTRAL] Yes, ma'am, uh-huh, it is.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, so give me just one moment.
[AGENT][NEUTRAL] OK, and what is the fax number that I can send this to, please?
[CUSTOMER][NEUTRAL] Sure, it's [PII].
[AGENT][NEUTRAL] OK, thank you. And will it need to have your attention put on there, [PII], or is that not necessary?
[CUSTOMER][NEUTRAL] Yeah, that's fine.
[AGENT][NEUTRAL] OK, so one moment while that information is loading.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And so I'll go ahead and give you this information, but once if, if you all file a claim with APO once it has been processed, we do have a portal in which you should be able to check our claim status and have access to our explanation of benefits, and our portal website is secured. [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, I'm sorry, what was that again? AM.
[AGENT][NEUTRAL] The first word is secured.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Good morning
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright then.
[AGENT][NEUTRAL] And the fax number again is [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] Alright, well I have just sent that to you so provided there's not any type of technical issue, you should be receiving that within just the next few minutes.
[CUSTOMER][NEUTRAL] OK, and can I get a reference number please?
[AGENT][NEUTRAL] Yes, ma'am, you would use my name along with today's date.
[CUSTOMER][POSITIVE] Alright well thank you so much for your time I appreciate it.
[AGENT][POSITIVE] Well, you are certainly very welcome and thank you again for calling APL. I hope you have a great weekend.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye-bye.