AccountId: 011433970860
ContactId: 6ce92504-7f44-4689-9e5c-92384a66e4ac
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 534169 ms
Total Talk Time (AGENT): 136013 ms
Total Talk Time (CUSTOMER): 104013 ms
Interruptions: 2
Overall Sentiment: AGENT=0.6, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/14/6ce92504-7f44-4689-9e5c-92384a66e4ac_20250514T18:38_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from oral and facial surgery of the Shoals calling to get benefits on a patient and to see if we're in a in or out of network.
[AGENT][NEUTRAL] You said, oral and facial surgery center, correct? Oh, sorry, that was a tongue twister for me.
[CUSTOMER][NEUTRAL] Oral and facial surgery of the shoals.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And do you have a policy number?
[CUSTOMER][NEUTRAL] 645622
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And can I get the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And oops data was not on this hold on sorry.
[AGENT][POSITIVE] You're OK.
[CUSTOMER][NEUTRAL] Date of birth is
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Great thank you so much for verifying that with me.
[AGENT][NEUTRAL] And have you submitted a claim already or are you checking for eligibility?
[CUSTOMER][NEUTRAL] I'm checking for eligibility and what her benefits are because she's here to see, so I want to do a pre-treatment um estimate for her.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, I just needed to know what she had available on her maximum, if her deductible has been met, and what percent of oral surgery is covered.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Her policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me see about her.
[AGENT][NEUTRAL] Benefits for you?
[AGENT][POSITIVE] And I do have a fax back that I can send you in regards to this policy if you would like. It does have um all great.
[CUSTOMER][POSITIVE] Mhm yeah that would be great.
[AGENT][NEUTRAL] Can I get a good fax number?
[CUSTOMER][NEUTRAL] [PII] excuse me [PII].
[AGENT][NEUTRAL] Let me start over. 256383 and then what?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] I'm gonna read it back to you just in case [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] Alright, I can give you this fax back.
[AGENT][NEUTRAL] Um, expect it to take a couple of hours. I should send that out to you in just a little bit. Is there anything else, anything else I can help you with?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there any way I could get it over the phone? Is there any way I could get it over the phone? because a couple of hours she'll be gone.
[AGENT][NEUTRAL] OK, um, do you have some procedure codes?
[CUSTOMER][NEUTRAL] Um, no, because she hasn't been in yet. Is it, is it on a fee schedule? What's the fee schedule?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Or is there a flat percentage of oral surgery that is covered or is it a fee schedule?
[AGENT][NEUTRAL] It is, let me check.
[AGENT][NEUTRAL] It gives a benefit amount so she does have a calendar year deductible of a maximum of up to $1000.
[AGENT][NEUTRAL] I'm sorry, a calendar year.
[AGENT][NEUTRAL] Maximum of $1000 with a calendar year deductible of $50 per covered person. Let me see.
[AGENT][NEUTRAL] If she's used any of that.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, may I ask who's calling?
[CUSTOMER][NEUTRAL] to stick with April or.
[AGENT][NEUTRAL] Alright, give me one moment. It's not pulling up for me, so give me just a second.
[CUSTOMER][NEUTRAL] That's OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Hey
[CUSTOMER][NEUTRAL] [PII], did you call on [PII], or were you expecting a call from her?
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] I apologize this is taking just a moment. My computer's running just a little slow right now.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] She is, yes, ma'am, 701.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Call a principal
[AGENT][NEUTRAL] OK, I am showing that [PII] has not used any of her benefits yet as of today.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And was there anything else you're needing besides that in the fax back?
[CUSTOMER][NEUTRAL] Yeah, I needed to know what percentage of oral surgery was being covered.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And they are flat rates, so it would depend on the procedure code.
[CUSTOMER][NEUTRAL] OK, so it is by fee schedule. Could you send me the fee schedule?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] That would be great.
[AGENT][NEUTRAL] Yes, and can I send it to that fax number that you just gave me or would you prefer? OK, OK.
[CUSTOMER][POSITIVE] Yes, yes. Nope, that'd be perfect.
[AGENT][POSITIVE] All right, I will get that out to you in just a moment. OK. Thank you so much. Have a great day and thank you for calling APL.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright thank you bye bye.
[CUSTOMER][NEUTRAL] You too.
[CUSTOMER][NEUTRAL] Mhm bye.
[AGENT][NEUTRAL] OK.