AccountId: 011433970860
ContactId: 826cabb9-3dd6-4df6-9310-84a5a3f27e33
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 240669 ms
Total Talk Time (AGENT): 137018 ms
Total Talk Time (CUSTOMER): 77713 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/30/826cabb9-3dd6-4df6-9310-84a5a3f27e33_20241230T17:57_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APO. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, good morning, my name's [PII] and I'm calling from a provider office.
[CUSTOMER][NEUTRAL] And I was trying to get a breakdown of benefits for patients. I'm not too familiar with this insurance.
[AGENT][POSITIVE] Sure, I can assist you with that. Can I have a callback number for you and the spelling of your name?
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Yes, it's gonna be [PII] and then my name is [PII]
[AGENT][NEUTRAL] Could you pronounce your name for me?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII]. Can I have the policy number of the member that you're inquiring eligibility for?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yes, it's gonna be 02273451.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, um, the patient will be the spouse, [PII] [PII], and then her date of birth is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You're calling to verify benefits and eligibility. Would you like for me to send you a schedule, a dental schedule by fax?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I can give you the other information that's not on it, but I know it's a lot of stuff. The policy is a, it's a open, it don't have a network, so it's an open network. It's not an HMO or PPO due to the the policy holder being a truck driver and he travels all over the world.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh I see OK.
[AGENT][NEUTRAL] But it's, it's an open network. It has no network. It's not an HMO or PPO. It's just a standard dental policy that covers dental services. The policy has been been active since [PII], and they have not used, they don't have any history on file, but the benefit amount is $1500 per calendar year with a $50 deductible. It does not apply to us preventative services, and this is not a guarantee of benefits, just a disclaimer of the policy's coverage.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, does this policy have any waiting periods?
[AGENT][NEUTRAL] There was a waiting period, however, it terminated, it terminated [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So now, it covers preventative at 100, basic at 80, and major at 40. Major endoeroprosthesis or surgery is covered at 40.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and.
[CUSTOMER][NEUTRAL] Well, the rest of the information be on the facts regarding like the 4341 if it's OK.
[AGENT][NEUTRAL] Yes, it's gonna have
[AGENT][NEUTRAL] It's gonna go, it's gonna have the calendar year max, the deductible, the category of expenses, the frequencies, where to submit a claim to. It's gonna have a a column with the procedure codes, the description of each procedure code, and the limitation is gonna be letters in parentheses, and those letters in parentheses on the very last page, it explains what each limitation is for each letter within parentheses.
[CUSTOMER][NEUTRAL] OK, can I give you that fax number where I could get the fax?
[AGENT][NEUTRAL] Yes, I was gonna give it to you. I mean, I was gonna ask you for, what's your fax number?
[CUSTOMER][NEUTRAL] OK, it's gonna be area code [PII].
[AGENT][NEUTRAL] I have [PII].
[CUSTOMER][NEUTRAL] [PII] yeah.
[AGENT][NEUTRAL] Alright, so I'm gonna send this over for you. Is there anything else that I can assist you? Mhm, go ahead.
[CUSTOMER][NEUTRAL] I have a question
[CUSTOMER][NEUTRAL] Regarding like where we I know I got the the PO box from online and there's a fax number. Can we fax claims to that [PII]?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, there's a fax number, so you can fax it in, there's a payer ID of 60801.
[CUSTOMER][NEUTRAL] OK, I'll make a note.
[CUSTOMER][NEUTRAL] OK, OK, that's all I needed.
[AGENT][POSITIVE] Alright, well thanks for calling APL and have a great day.
[CUSTOMER][POSITIVE] Thank you bye.
[AGENT][POSITIVE] You're welcome. Bye bye.