AccountId: 011433970860
ContactId: 65d5d0e8-109a-441d-b189-5ed1ab8b08bb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 344230 ms
Total Talk Time (AGENT): 130821 ms
Total Talk Time (CUSTOMER): 187802 ms
Interruptions: 3
Overall Sentiment: AGENT=0.7, CUSTOMER=1.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/65d5d0e8-109a-441d-b189-5ed1ab8b08bb_20250313T14:01_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Good morning [PII]. I am calling to verify my patient's orthodontic coverage and benefits.
[AGENT][NEUTRAL] OK, I can verify benefits for you and your name is?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK, and Mr. [PII], what's that policy number, please?
[CUSTOMER][NEUTRAL] They actually did not provide it, but I do have the policy holder's social as well as name and date of birth.
[AGENT][NEUTRAL] Uh, give me one moment. Uh, what's the social?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] That is going to be
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and the patient's name?
[CUSTOMER][NEUTRAL] Patient is gonna be [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you so much. Give me a moment. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yes ma'am, that's gonna be [PII].
[AGENT][NEUTRAL] OK, thank you, ma'am. And let's see. And you say you're calling to verify eligibility and ortho benefits, is that correct?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK, I'm showing an effective date of [PII] policy is active, but with this policy, ortho it's not covered. Uh, the policy doesn't cover any major services.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yes ma'am, and with this policy or with yeah, with the policy renew on a calendar year or a plan year?
[AGENT][NEUTRAL] Uh, it's a calendar year.
[CUSTOMER][POSITIVE] Excellent and may I have the group name and number?
[AGENT][NEUTRAL] Uh, sure. Let's see, group number 70,050.
[AGENT][NEUTRAL] And the group name is at, oh Lord, I can't pronounce words, it's A D E P T.
[AGENT][NEUTRAL] Adep HR Incorporated.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Excellent and um may I verify that [PII] is the policy holder?
[AGENT][NEUTRAL] He is, yes, ma'am.
[CUSTOMER][POSITIVE] Excellent. And would you be able to provide that alternate ID or can we just put his um social in there for storage? Yes ma'am.
[AGENT][POSITIVE] Oh yes, thank you for reminding me. Um, I can give you that policy number when you're ready.
[CUSTOMER][POSITIVE] Alrighty, I am ready.
[AGENT][NEUTRAL] OK, it's 2603734.
[CUSTOMER][NEUTRAL] Perfect and then um just need to verify that he is the policyholder. I think I just asked you that sorry.
[AGENT][NEUTRAL] No, you're fine. Yes, ma'am, he is.
[CUSTOMER][NEUTRAL] Alright, and lastly just to make sure I have the correct carrier information, may I have the claims mailing address?
[AGENT][NEUTRAL] Uh yes, it's uh [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Alright, and that is different from we what we have in the system, so, oh, actually.
[CUSTOMER][NEUTRAL] We do have that number a couple of times just that no one updated it. Hold on a second. It said back in [PII] it said that was the uh mailing address about a year now, so let me put.
[AGENT][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] A note in that it changed in [PII] yeah we've got uh [PII] address not sure why that's still in there and then um just to make sure with that group, I'm sorry, would that address be group specific or would all claims need to go to that address?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All claims go to that address. Uh, we changed our address, uh, like you said in [PII] [PII], so yeah.
[CUSTOMER][POSITIVE] Yeah, OK, I'm like I'm not sure why we have the notes in there, but nobody actually went into the carrier information and updated it, so let me make sure I clean up. I see, and you know, no, never mind, I'm not gonna complain. I'm gonna just do what I'm supposed to do. Yeah, it's like I'm gonna do what I'm supposed to do. I'm gonna do it correctly like you said.
[AGENT][NEUTRAL] They was waiting for you.
[AGENT][NEUTRAL] We're just gonna let it go, let it go.
[AGENT][NEUTRAL] There you go.
[CUSTOMER][NEUTRAL] And um we're gonna get it updated. OK, I think that's everything that I need to like I know they ask if claims go to the old address or they're gonna be forwarded and all that stuff um but after all this time.
[AGENT][NEUTRAL] Would you like a copy of the, the fax back? It has our address, payer ID and um
[AGENT][NEUTRAL] Fax number for claims if you like.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] Yes, I will actually take that and I'm gonna make a note that you all do have a fax back. um, I do have that fax number whenever you're ready.
[AGENT][POSITIVE] OK, I'm ready.
[CUSTOMER][NEUTRAL] That is gonna be [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, that's [PII].
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, I will fax this over in a few moments.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Um let me double check.
[CUSTOMER][POSITIVE] Perfect thank you so much [PII] and let me see, um, would there be a reference number available or just your name and today's date?
[AGENT][NEUTRAL] Uh, you may use my name in today's date.
[CUSTOMER][POSITIVE] Excellent thank you so much for all of your help. I will be looking forward to that fax back.
[AGENT][POSITIVE] All right. Well, I thank you for calling APL Ms. [PII]. You have a great rest of your day.
[CUSTOMER][POSITIVE] Yes, ma'am. You're welcome. You too. Thanks. Bye-bye.
[AGENT][NEUTRAL] Um bye.