AccountId: 011433970860
ContactId: 6e6c88c7-7668-491c-98c6-c5382ab1f18b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 400380 ms
Total Talk Time (AGENT): 166498 ms
Total Talk Time (CUSTOMER): 97770 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/6e6c88c7-7668-491c-98c6-c5382ab1f18b_20250313T14:41_UTC.wav
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[AGENT][POSITIVE] Thank you for calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], I was calling to verify dental benefits for a patient.
[AGENT][NEUTRAL] OK, I can help you with that. May I have your name and a callback number?
[CUSTOMER][NEUTRAL] Yeah it's [PII] and [PII].
[AGENT][NEUTRAL] Thank you. And what is the policy number you're calling on?
[CUSTOMER][NEUTRAL] Um, I just have the social. Are you able to pull it up by the social?
[AGENT][NEUTRAL] Yes, hold one moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, what is the social?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] The patient's name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you could verify his date of birth, please.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, thank you. And you did say you were calling for benefits today?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. Would you like me to fax over a complete breakdown of his benefits?
[CUSTOMER][NEUTRAL] Um, you can, and then I'll have some additional questions.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And that um that fax back will include their maximum and deductible and if anything's been used from it.
[AGENT][NEUTRAL] Now, it won't, uh, I can tell you now if anything's been used or met, um, it will not have that information on there.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I wonder why.
[CUSTOMER][NEUTRAL] That seems like a crucial part of getting a fax back.
[AGENT][NEUTRAL] Yeah, it's just uh with the fee schedule, letting you know what procedures are covered and at what percentage.
[CUSTOMER][POSITIVE] Got you.
[AGENT][NEUTRAL] OK. And let me get his benefits pulled up.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, please be advised verifying benefits is not guaranteed payment.
[AGENT][NEUTRAL] His policy has been effective with us since [PII]. It is still active.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] And what, uh,
[AGENT][NEUTRAL] Questions do you have regarding uh the policy?
[CUSTOMER][POSITIVE] Well, let's start with the remaining benefits.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let's see, so the policy pays up to $1000 a calendar year. At this time I show $89 has been used towards, uh, it's $1000.
[CUSTOMER][NEUTRAL] OK, and what about the deductible?
[AGENT][NEUTRAL] Uh, let's see, the policy has a $50 per person deductible. Let me check and see if that has been met.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, it appears he has met his deductible at this time.
[CUSTOMER][NEUTRAL] OK, and does the policy accept assignment of benefits for out of network providers?
[AGENT][POSITIVE] Yes, it does.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] Uh, I do apologize. I show his deductible for 20 0, hold on, let me put it in there.
[AGENT][NEUTRAL] He does still have the uh.
[AGENT][NEUTRAL] $50 remaining.
[CUSTOMER][NEUTRAL] OK, so he has not used it?
[AGENT][NEUTRAL] He has not.
[CUSTOMER][NEUTRAL] OK and then um.
[CUSTOMER][NEUTRAL] If I give you some procedure codes in our office fee, are you able to tell me if we are within or below your loud amount?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Let me see what is the procedure?
[CUSTOMER][NEUTRAL] Um, I have 3 codes. The first one is 3330.
[AGENT][NEUTRAL] 33
[AGENT][NEUTRAL] OK, it looks like the for $33,330 the policy pays up to $383.
[CUSTOMER][NEUTRAL] OK, and is there a percentage of that or is it 100%?
[AGENT][NEUTRAL] Let me see, this is under major.
[AGENT][NEUTRAL] I shall please be advised verifying benefits is not guaranteed payment for major benefits, the policy pays.
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Where is that
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, it looks like it pays up to 100% of that.
[CUSTOMER][NEUTRAL] OK, um, and then I have two other codes. I have 2950.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You want them all together or one at a time?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] One at a time, 29, 50.
[CUSTOMER][NEUTRAL] OK, yeah, 2950.
[AGENT][NEGATIVE] Shows it pays 100% of its $79 applied to this procedure.
[CUSTOMER][NEUTRAL] OK, and then the last code is 3221?
[AGENT][NEUTRAL] Hm, I do not show 3221 being a covered procedure.
[CUSTOMER][NEUTRAL] Alright, and is the payer ID 60801?
[AGENT][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] Alright, and the mailing address is gonna be [PII]?
[AGENT][POSITIVE] That is correct. Yes, ma'am.
[CUSTOMER][POSITIVE] All right perfect that's all the questions I had for you thank you.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] Nope, that's it thanks.
[AGENT][POSITIVE] You're welcome. Have a wonderful day. Thank you for calling APL. Bye bye.
[CUSTOMER][POSITIVE] You have a good one bye bye.