AccountId: 011433970860
ContactId: 82b858ef-22a9-4901-9efc-5446bd5ed7b4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 325179 ms
Total Talk Time (AGENT): 162411 ms
Total Talk Time (CUSTOMER): 70054 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/14/82b858ef-22a9-4901-9efc-5446bd5ed7b4_20250114T18:04_UTC.wav
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[AGENT][NEUTRAL] Hi, thank you for calling APL. This is [PII]. How can I help you today?
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII] calling from Market Dental. I need to verify the patient's eligibility and benefit details. Could you assist me regarding this?
[AGENT][POSITIVE] Yes, I absolutely can. So we're looking at eligibility and benefits today for you, and can I get your name please?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Thank you [PII] and what's a great callback number for you?
[CUSTOMER][NEUTRAL] [PII] renting extension is [PII].
[AGENT][NEUTRAL] Thank you and the member's policy number?
[CUSTOMER][NEUTRAL] 614-6112.
[AGENT][NEUTRAL] 614-612?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] Would you be able to verify for me pretty please your patient's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Patient's first name is [PII] is the first name and the last name is [PII], [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you. I appreciate that.
[AGENT][NEUTRAL] Perfect and I do see your patient here. It looks like they've been effective since [PII] and for benefits, are you wanting a fax back?
[CUSTOMER][NEUTRAL] So yeah, uh, could you, I would like to go with the verbal. Could you assist me with them deductibles and annual mics for this patients plan?
[AGENT][POSITIVE] Yes, absolutely, um, give me a moment to get their, uh, fax back pulled up so I can go over it with you.
[AGENT][NEUTRAL] I do wanna let you know that any benefit information I give you over the phone is a verification of coverage and not a guarantee of payment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] And sorry, just one more second.
[AGENT][NEUTRAL] Perfect, um, so your patient has a calendar year maximum of $1000 with us, um, that also includes a $50 deductible, but, um.
[AGENT][NEUTRAL] But the deductible does not apply to exams or pro fees.
[CUSTOMER][NEUTRAL] OK, can I get the insurance for the preventative basic measure?
[AGENT][NEUTRAL] All right, so there is no coinsurance listed. There's an individual benefit amount next to each CPT code.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I'd like to confirm it's in a co-pay policy, right?
[AGENT][NEUTRAL] No, no, the, it has its own, um, schedule of benefits on it and so each code has a benefit amount listed next to it.
[CUSTOMER][NEUTRAL] Uh, could you go with the group number?
[AGENT][NEUTRAL] The group number? Yeah, let me get that for you.
[AGENT][NEUTRAL] I have the group number. Oh, there is no group number on this phone. I'm sorry.
[AGENT][NEUTRAL] It's a personal policy.
[CUSTOMER][NEUTRAL] Group group name?
[AGENT][NEUTRAL] There's no group, it's a personal policy.
[CUSTOMER][NEUTRAL] OK, I need to confirm the uh effective date for this patients plan.
[AGENT][NEUTRAL] Yep, that was the [PII] or [PII].
[CUSTOMER][NEUTRAL] [PII] is the patient is a policyholder for this plan, right?
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Is there any used amount from the annual max?
[AGENT][NEUTRAL] Yeah, let me take a look at their.
[AGENT][NEUTRAL] Um, calendar year benefits.
[AGENT][NEGATIVE] Uh, so far we have not used any benefits for the calendar year.
[CUSTOMER][NEUTRAL] Is there any waiting period for this policy?
[AGENT][NEUTRAL] Um, no, there's no waiting period.
[CUSTOMER][NEUTRAL] Is there any history for this patient file?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let's take a look.
[AGENT][NEUTRAL] I do have a history for you.
[AGENT][NEUTRAL] It looks like the last time they were seen was 7-16-2024.
[AGENT][NEUTRAL] Um, they had, I
[CUSTOMER][NEUTRAL] And may I know which code it it applies to which code?
[AGENT][NEUTRAL] You wanna know each code from that visit?
[CUSTOMER][NEUTRAL] Yeah, [PII] of [PII], the code, it applies for which code.
[AGENT][NEUTRAL] Yeah, so they had [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 0110.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, they had 00274, but we didn't pay anything on it, so they might be eligible for benefits there. Um, they had 00120.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that was it from that date of service.
[CUSTOMER][NEUTRAL] OK, if you don't mind, may I have your name and call reference number please?
[AGENT][NEUTRAL] Oh yeah, you bet you. My name is [PII], first initial, last name [PII]. Um the call reference is my name, my last initial and today's date.
[CUSTOMER][POSITIVE] Thank you, thank you, [PII]. Thank you for providing me all the information. Have a nice day.
[AGENT][POSITIVE] Yeah it's my pleasure [PII] thank you for calling you have a wonderful day as well.