AccountId: 011433970860
ContactId: 79d2a7fc-c1c0-4072-afde-b98602bf4054
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 447640 ms
Total Talk Time (AGENT): 110332 ms
Total Talk Time (CUSTOMER): 101136 ms
Interruptions: 1
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/79d2a7fc-c1c0-4072-afde-b98602bf4054_20250219T20:36_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling with Martin Dental just checking on the status of a pre-authorization that was submitted.
[AGENT][NEUTRAL] May I have a callback number and then the policy number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Do you need the policy number or the ID number?
[AGENT][NEUTRAL] The member's policy number.
[CUSTOMER][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] I have a group number of 14938.
[CUSTOMER][NEUTRAL] And ID number of 02555230.
[AGENT][NEUTRAL] May I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And then date of birth is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] And thank you so much [PII] for verifying the policy you're calling in regards to a pre-authorization that was requested or submitted in.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so for this policy it's not showing that a pre-au is required.
[CUSTOMER][NEUTRAL] So there's no way to have one run through when it's over. I mean this is $3600 worth of treatment.
[AGENT][NEUTRAL] We, uh, once we receive the claim, the initial claim, then we will process that information but we don't go off of an estimate or pre-treatment.
[CUSTOMER][NEUTRAL] So we have no idea of what your coverage will actually be for treatment.
[AGENT][NEUTRAL] Have you requested a fax back for this member's policy?
[CUSTOMER][NEGATIVE] I have a breakdown of benefits, but we are out of network so that really doesn't get us anywhere when I don't know your UCR.
[AGENT][NEUTRAL] Let me pull this member's information up.
[AGENT][NEUTRAL] May I have the first digits of your zip code please?
[CUSTOMER][NEUTRAL] The first digit?
[AGENT][NEUTRAL] The 1st 3 digits.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And may I have one of the procedure codes?
[CUSTOMER][NEUTRAL] 2393.
[AGENT][NEUTRAL] And that was 547 for the first three digits.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] But it's not like
[CUSTOMER][NEUTRAL] To work on that
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] In
[CUSTOMER][NEUTRAL] Yeah I mean at some point.
[CUSTOMER][POSITIVE] Great, so that's a preventative option.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, but you know.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so upon pulling this member's information, the only thing that could be disclosed is just to let you know that it is the 80% of the UCR. Once that claim is received, then that examiner will review it and process and make that payment up to that amount, then the EOB will be issued out to the provider, which will indicate if the member has any responsibility or not.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Have
[CUSTOMER][NEUTRAL] I understand that but.
[CUSTOMER][NEUTRAL] Patient isn't going to do services if she doesn't know how much it's going to cost her so is she able to call and get the UCR?
[AGENT][NEUTRAL] Maybe they, uh they may be able to give her the UCR I'm not seeing that listed on here, but they may be the processor or the person in dental may be able to disclose that information to her.
[CUSTOMER][NEUTRAL] OK, that's
[AGENT][NEUTRAL] But they normally don't process claims over the phone, so that's why a dollar amount is not given.
[CUSTOMER][NEUTRAL] Well, I'm not asking you to process a claim. I'm just asking you what your UCR is so I can calculate it myself because you won't.
[AGENT][NEUTRAL] That will give a dollar amount so we can't give a dollar amount over the phone.
[CUSTOMER][NEUTRAL] Hypothetically, if we were in network do you process anything prior to actual claim submission?
[CUSTOMER][NEUTRAL] Or do you let them know what the charges are?
[AGENT][NEUTRAL] We will only process the claim once we receive that information. We do not process a claim over the phone. We don't give any detailed information over the phone.
[CUSTOMER][POSITIVE] Alright, I will have the patient reach out thank you.
[AGENT][POSITIVE] You're welcome, thank you for calling American Public Life, have a great day.