AccountId: 011433970860
ContactId: 83f2d9bd-33c5-4523-844b-a9f972a07bfa
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 555090 ms
Total Talk Time (AGENT): 217525 ms
Total Talk Time (CUSTOMER): 154560 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/29/83f2d9bd-33c5-4523-844b-a9f972a07bfa_20250529T13:06_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey, good morning, Miss [PII]. My name is [PII] and I was calling for uh patient benefit information this morning. How are you?
[AGENT][POSITIVE] I'm doing well. How are you doing today?
[CUSTOMER][POSITIVE] Good, thank you for asking.
[AGENT][NEUTRAL] You're welcome. And [PII], may I have a good contact number in case we're disconnected and the member's policy number?
[CUSTOMER][NEUTRAL] Yes, ma'am. My number is direct at [PII] and the member ID is 02006310.
[AGENT][POSITIVE] Thank you and you said you um needed benefit information correct?
[CUSTOMER][NEUTRAL] Correct, yes ma'am. I'm more so need to see if we're in network with this patient's policy as well.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Do you need the member or the policy holder or the patient or the policy holder?
[AGENT][NEUTRAL] I'm the patient.
[CUSTOMER][NEUTRAL] OK, the patient's [PII] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. Let me see what type of policy they have. Hold on one moment.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] Alright, so I am showing the policy is active. It's been effective since [PII], and I'm just waiting for the fax back to populate. Um, so this policy is not on a, um, a network.
[CUSTOMER][NEUTRAL] OK, so it's basically like it's, it's an indemnity plan, it doesn't follow any fee schedule?
[AGENT][NEUTRAL] Um, it goes off of usual and customary charges. Um, it has like the percentages. I can send you a copy of the fax back if you'd like.
[CUSTOMER][NEUTRAL] Yes, ma'am, but can I go ahead and get some information from you as well?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Um, do you need my fax number as well?
[AGENT][POSITIVE] Yes, um, if you like me to send it now, yes, I can um send it to you now.
[CUSTOMER][NEUTRAL] OK, yes, ma'am, just let me know whenever you're ready.
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] 8603
[AGENT][NEUTRAL] And should I put attention [PII]?
[CUSTOMER][POSITIVE] Yes, ma'am, if you don't mind.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] Alright, so I just sent that off to you. And then what questions did you have about the policy?
[CUSTOMER][NEUTRAL] Does the policy have a waiting period or a missing tooth clause?
[AGENT][MIXED] It does have a missing tooth cloth and it also has a waiting period of 12 months, um, but that has been satisfied.
[CUSTOMER][NEUTRAL] OK. And can I have the effective date?
[AGENT][NEUTRAL] Yes, [PII].
[CUSTOMER][POSITIVE] Perfect. And then, um,
[CUSTOMER][NEUTRAL] Does the policy pay the provider or the patient since we're technically not in network?
[AGENT][NEUTRAL] Um, it could be either or, but most of the time it's the provider.
[CUSTOMER][NEUTRAL] OK, so they accept assignment of benefits?
[AGENT][POSITIVE] Yes, we do.
[CUSTOMER][NEUTRAL] OK. And then, um, does the policy require that I file a medical first or can I file straight to dental?
[AGENT][NEUTRAL] Um, there is no requirements, however, we receive it, we'll process the claim.
[CUSTOMER][POSITIVE] OK. Wonderful. And then I have a total of 5 codes. Can you let me know if any of these are covered under the policy?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Did you want them all at once or one at a time?
[AGENT][POSITIVE] All at once it's fine.
[CUSTOMER][NEUTRAL] Uh, just let me know whenever you're ready.
[AGENT][POSITIVE] OK, I'm ready.
[CUSTOMER][NEUTRAL] 725072107953
[CUSTOMER][NEUTRAL] 6010 and 9223.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 7250 is under oral surgery at 40%.
[AGENT][NEUTRAL] As well as 7210.
[AGENT][NEUTRAL] 7953 is not covered on the policy?
[AGENT][NEUTRAL] 6010 is not covered on the policy?
[AGENT][NEUTRAL] Um, and neither is 9223.
[CUSTOMER][NEUTRAL] OK. And then um can you confirm the patient's group number and claims filing address, please?
[AGENT][NEUTRAL] Yes, our mailing address is [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[AGENT][NEUTRAL] And um the group number is 15844.
[AGENT][NEUTRAL] And that's for universal Trucking.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Universal tracking, OK.
[CUSTOMER][NEUTRAL] And what's the patient's maximum and deductible information?
[AGENT][NEUTRAL] Hold on one second. The calendar year max is $1500 per coverage insured.
[AGENT][NEUTRAL] The deductible is $50 per person up to $150 per family, and does not apply to preventative.
[CUSTOMER][NEUTRAL] OK. Have they used anything?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] Oh, so [PII] has met the deductible?
[AGENT][NEUTRAL] And let me see how much he's used, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And [PII], do you mind if I place you on just a brief hold?
[CUSTOMER][POSITIVE] That's fine. Thank you.
[AGENT][NEUTRAL] You're welcome, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] I'm like, wait a minute, that's a.
[AGENT][NEUTRAL] Health thing. Why does it look like that?
[AGENT][POSITIVE] Glad I caught that.
[AGENT][POSITIVE] Oh, but it was still wow.
[AGENT][NEUTRAL] So it's still correct. OK then. I didn't know you can do that, but I'm not gonna do it no more, but uh.
[AGENT][NEUTRAL] OK, hello [PII].
[CUSTOMER][NEUTRAL] Yes, m[PII].
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So, um, yes, [PII] has met the $50 deductible. He's used $179.20 of the max. He has $1320.80 left for the year.
[CUSTOMER][NEUTRAL] Perfect. And then my last question for you, can you see if he's eligible for an exam and panoramic X-ray? The exam code is the 0150 and the pan is the 0330.
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] Um, no, his last date of service for the 00150 was [PII], and let me see the other.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And for 00330, um, he hasn't, there's no history on file for that code.
[CUSTOMER][NEUTRAL] So he's eligible for the 0330 but not the 0150?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and then that is eligible for the 0330 at 100%, right?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, 0330 is panoramic, which is 80% under radiographs and FMX.
[CUSTOMER][POSITIVE] OK, perfect. Alright, Miss [PII], if I can just have a reference number for the call please.
[AGENT][NEUTRAL] So there's no call reference number, but you can use my name and today's date. The first initial to my last name is [PII].
[CUSTOMER][POSITIVE] Perfect. Thank you so much. Have a great day.
[AGENT][NEUTRAL] You're welcome, [PII]. Was there anything else I can help with?
[CUSTOMER][POSITIVE] That's it. Thanks so much.
[AGENT][POSITIVE] Alright, thanks for calling APL. You're welcome. Bye bye.
[CUSTOMER][NEUTRAL] Bye-bye.