AccountId: 011433970860
ContactId: 6c952a73-a1fb-4e70-b7e0-954f74560a91
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 427000 ms
Total Talk Time (AGENT): 182300 ms
Total Talk Time (CUSTOMER): 124087 ms
Interruptions: 2
Overall Sentiment: AGENT=1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/6c952a73-a1fb-4e70-b7e0-954f74560a91_20250331T20:28_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] Yes, I was calling to verify dental benefits and check for history on a patient.
[AGENT][NEUTRAL] OK, you're needing to verify dental eligibility and history. Is that correct? Get history information?
[CUSTOMER][NEUTRAL] Yes, yes, ma'am.
[AGENT][NEUTRAL] Yes ma'am, I can help you with that and if you need uh the benefit information on the member's plan, we have 5 backs of the benefits depending on the policy they have that I'll send to you. Also, it won't have history on there but it'll have all of their benefits. So first off, who am I speaking with please?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] with Carriinel.
[AGENT][NEUTRAL] Thank you. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you. And the member's policy number, please.
[CUSTOMER][NEUTRAL] 01885798.
[AGENT][NEUTRAL] OK, thank you one moment while I get the member's information pulled up.
[AGENT][NEUTRAL] And any information that I do provide for you today, [PII] will 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 going to be for [PII]. I'm not sure, [PII] That's the date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Just one moment.
[AGENT][NEUTRAL] OK, so I do show that he is the subscriber on this dental plan and it is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you have certain codes that you're wanting to check history for?
[CUSTOMER][NEUTRAL] Um, I guess that mainly the preventative codes, the X-rays.
[AGENT][NEUTRAL] OK, so
[CUSTOMER][NEUTRAL] Do you need me to give you the codes?
[AGENT][NEUTRAL] I do. Mhm, that you won't checked for history.
[CUSTOMER][NEUTRAL] OK, so 0150 um 033 OK.
[AGENT][NEUTRAL] All right, just a moment. Now, let's, yeah, we're gonna have to do them one at a time.
[CUSTOMER][POSITIVE] OK, that's fine, no worries.
[AGENT][NEUTRAL] There's no history for 0150?
[CUSTOMER][NEUTRAL] 5 0120.
[AGENT][NEUTRAL] 97 of 2023.
[CUSTOMER][NEUTRAL] OK, uh 0330.
[AGENT][NEUTRAL] No history.
[CUSTOMER][NEUTRAL] 0210 and then of course they might share frequency I don't know.
[AGENT][NEUTRAL] No history?
[CUSTOMER][NEUTRAL] OK, um 0274?
[AGENT][NEUTRAL] I'll say 97 of 23.
[CUSTOMER][NEUTRAL] OK, 1110.
[AGENT][NEUTRAL] No history.
[CUSTOMER][NEUTRAL] Mm did they maybe have a 4341?
[AGENT][NEUTRAL] 420 of 2022.
[CUSTOMER][NEUTRAL] And then I guess the pay on maintenance.
[AGENT][NEUTRAL] What's the code? That's OK.
[CUSTOMER][NEUTRAL] 0 4910. I'm sorry.
[CUSTOMER][NEUTRAL] 4910
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] 97 of 23.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So nothing's been none of his Mac or anything's been used for this year.
[AGENT][NEUTRAL] Let me double check that for you.
[CUSTOMER][NEGATIVE] But I have an issue
[CUSTOMER][NEUTRAL] I'll put it here
[AGENT][NEGATIVE] Uh, no, ma'am. As of now, there have not been any benefits used.
[CUSTOMER][NEUTRAL] OK, and it looks like they're OK to do exam and X-rays then.
[CUSTOMER][NEUTRAL] Um, so the fax that you send, will it have the frequencies and limitations and all that good stuff?
[AGENT][NEUTRAL] Um,
[AGENT][POSITIVE] Oh, I'm sorry.
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] It will.
[AGENT][NEUTRAL] They will have every bit of that, our mailing address, our payer ID, the calendar, your max, all of that's on there, and anything not on the fax back, uh, [PII] means it would not be covered.
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][NEUTRAL] Now, does the facts need to be put to your attention or is that not necessary?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's gonna go straight to me.
[AGENT][NEUTRAL] OK, alright, so give me just one moment there.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is your fax number, please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. Again, that was [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK. So that has just been sent to you. So provided there's not any type of technical glitch, you should be receiving that uh very soon.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and can you tell me what the fee schedule is?
[AGENT][NEUTRAL] This is not a network plan. The covered services are based on a percentage of the UCR of the service region, and that information is also stated on that fax back.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] OK, OK, alright, thank you.
[AGENT][NEUTRAL] Yes ma'am, and you're welcome and then one last thing, [PII], if you all end up filing a claim with APL once it has been processed by us, we have a portal that you should be able to check claim status in and our website for the portal is secured.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Yes it's
[CUSTOMER][NEUTRAL] You want my email?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII] OK.
[AGENT][POSITIVE] Yes, ma'am. All right. Well, is there anything else I can help you with? Yeah, you're welcome.
[CUSTOMER][POSITIVE] All right, thank you.
[CUSTOMER][NEUTRAL] That's all.
[AGENT][POSITIVE] OK, well thank you for calling APL and I hope you have a very nice rest of your day.
[CUSTOMER][NEUTRAL] My
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][POSITIVE] You're welcome. Thank you. Bye-bye.
[CUSTOMER][NEUTRAL] Mm bye.
[CUSTOMER][NEUTRAL] Oh,