AccountId: 011433970860
ContactId: 7fbeb1b4-44f7-4e76-9600-b78e5c82c52f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 341040 ms
Total Talk Time (AGENT): 200387 ms
Total Talk Time (CUSTOMER): 99854 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/23/7fbeb1b4-44f7-4e76-9600-b78e5c82c52f_20250123T15:49_UTC.wav
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[AGENT][NEUTRAL] Contacting APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII], and I'm calling from uh [PII]. I was hoping for some help about verifying a patient's um eligibility for you guys and then also to see if we're providers because I have never heard of this insurance before.
[AGENT][NEUTRAL] OK, well, I can certainly help with that, [PII]. What is the policy number, please?
[CUSTOMER][NEUTRAL] Sure it is do do do do oh I just had it up of course OK uh D as in dog.
[CUSTOMER][NEUTRAL] 468.
[CUSTOMER][NEUTRAL] 02241
[AGENT][NEUTRAL] How do you spell the patient's last name, please?
[CUSTOMER][NEUTRAL] Sure, it's [PII]
[AGENT][POSITIVE] Thank you. And the first name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Oh sure uh let's see [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, that's great. And I'm, I'm sorry, but I forgot to ask, what is uh [PII]'s date of birth, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. His policy number is 02.
[AGENT][NEUTRAL] 58
[CUSTOMER][NEUTRAL] 0
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] 5046.
[CUSTOMER][NEUTRAL] 046
[AGENT][NEUTRAL] This went into effect on [PII]. It is active, and what this policy is, is it's a limited benefit dental policy. There is, there is no network. So you were, you were asking about a network. There is no network. Um, it pays a flat rate benefit, um, excuse me, I'm sorry, it pays a limited benefit. There is that $500 per calendar year as the maximum, that's just a verification of benefits, not a guarantee of payment, and it covers basic.
[AGENT][NEUTRAL] Basic restorative and preventative services only. Now, I have a um printout that I can send to you that tells you exactly what is covered and what we pay on it as well as where to send your claim, um, but uh I, I just need to let you know that there's no major coverage such as endoontics, periodontal services, oral surgery, dentures, that sort of thing. This is just very, very basic services.
[CUSTOMER][NEUTRAL] Got you. OK, so it's just a dental plan, not even like a medical plan he could use it as primary care office.
[AGENT][NEUTRAL] Now, he does have a medical plan as well. Uh, that's slightly different. Um, now, the, the medical plan, um, is a limited benefit policy that pays a flat rate benefit for certain services. So, for example, um, if he is, um,
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Uh, it, it will be as an ER visit. Uh, it, it pays a flat rate benefit of $50 for two of those per calendar year. Again, just a verification, not a guarantee of payment. So what type of services perhaps it would be best if I knew what he was coming in for and then that way I can give you a little better idea of what what we pay and where to send your claim.
[CUSTOMER][NEUTRAL] Definitely, so yeah, I'm calling from his primary um care clinic, um, his PCP's office so usually he would either come in for an office visit for like either a physical or like you know if he's feeling unwell like an office visit, um, or any like blood work that needs to be done, usually that that would get done here.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] The, um, the policy has 4 office visits for calendar year. It pays a flat rate benefit of $50. Uh, again, just a verification, not a guarantee of payment. The, uh,
[AGENT][NEUTRAL] Claims
[AGENT][NEUTRAL] Will be sent um I can find the.
[AGENT][NEUTRAL] These claims normally will go to um IMA their uh address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So, um, again, it's IMA.
[AGENT][NEUTRAL] [PII]. It's [PII].
[AGENT][NEUTRAL] [PII]. The payer ID is 64.
[AGENT][NEUTRAL] 556. Now, what will be covered on this will be the office, the, the other services, the, the, the blood work, that sort of thing is not covered on these policies.
[CUSTOMER][POSITIVE] Got you OK.
[CUSTOMER][NEUTRAL] And like you were saying before, there's no like in network or out network benefits just flat no matter what.
[AGENT][NEUTRAL] Yes, that's correct. Because it is a limited benefit policy, there, there are no um uh network and that goes for his his dental insurance too.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and that, um, that pays at $500 is that, um, I just wanna make sure I understood correctly, so is that the $50 that gets paid to us or is that a co-pay for the patient?
[AGENT][NEUTRAL] It is the the payment that is paid to whoever files the claim.
[CUSTOMER][POSITIVE] Got you OK.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Is there anything else at all that I may help with? Um, did you have any questions that, is it just the medical that we're looking at, I, I assume?
[CUSTOMER][NEUTRAL] Yep, just the medical today mhm.
[AGENT][NEUTRAL] Oh, OK, OK. Is there anything else at all that I may help with?
[CUSTOMER][POSITIVE] No, that was it thank you you've been really helpful.
[AGENT][POSITIVE] OK, well thank you for contacting ATO. If you have any other questions, please just let us know otherwise have a good day.