AccountId: 011433970860
ContactId: 86b2bf66-95dd-44b3-b3c9-3e40d171a446
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 378399 ms
Total Talk Time (AGENT): 183434 ms
Total Talk Time (CUSTOMER): 126045 ms
Interruptions: 0
Overall Sentiment: AGENT=2.4, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/86b2bf66-95dd-44b3-b3c9-3e40d171a446_20250110T15:51_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] Hello [PII], this is [PII]. I'm calling from my small dental team. How are you?
[AGENT][POSITIVE] I'm doing well, thank you for asking. How are you today?
[CUSTOMER][POSITIVE] Good. I wanted to get um a patient's benefits and details.
[AGENT][POSITIVE] Well, it would be my pleasure to assist you. Do you mind spelling your name for documentation?
[CUSTOMER][NEUTRAL] Sure, [PII]
[AGENT][POSITIVE] Thank you and what is a good callback number, please?
[CUSTOMER][NEUTRAL] It would be [PII].
[AGENT][NEUTRAL] Thank you and what is the policy number for the patient, please?
[CUSTOMER][NEUTRAL] Uh, so the patient is a dependent, but the ID number is 02321550.
[AGENT][NEUTRAL] Thank you, and shelling the patient's name and date of birth.
[CUSTOMER][NEUTRAL] Patient's name is [PII] [PII].
[AGENT][POSITIVE] Alright, thank you. It would be my pleasure to assist you with eligibility and benefits for [PII]. I am showing that her policy is active. The effective date is [PII]. This is for dental, correct?
[CUSTOMER][NEUTRAL] Yes, it is.
[AGENT][NEUTRAL] OK, good. Yeah, the policy is active as of this time she has not used any of her benefits for [PII].
[AGENT][NEUTRAL] 5
[CUSTOMER][NEUTRAL] Now, quick question. Now, the patient had extractions done in [PII].
[CUSTOMER][NEUTRAL] Uh, was the waiting period applied towards that too?
[AGENT][NEUTRAL] Yes, so with the effective date of [PII], there was a 12 month waiting period for any major procedures, so those were not major procedures were not considered for benefits until [PII].
[AGENT][NEUTRAL] And that waiting period she has met that.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] OK, and uh if I um give you a page of uh providers in [PII], can you help me see if the providers in network or not?
[AGENT][NEUTRAL] This policy does not participate in a network. We paid a percentage of UCR usual customary rate.
[CUSTOMER][NEUTRAL] Oh, OK, sounds good. What's the coverage?
[AGENT][NEUTRAL] So they can go to any provider.
[CUSTOMER][POSITIVE] Perfect, sorry about that sorry I cut you off.
[AGENT][POSITIVE] No problem.
[CUSTOMER][NEUTRAL] Um, what's, uh, the percentage coverage for D4341 SRP?
[AGENT][NEUTRAL] That is going to be 40% as it's considered major and I do have a breakdown I can fax to you with the calendar your max deductible frequencies, limitations, billing information and the codes listed if you would like.
[CUSTOMER][POSITIVE] Of course, yeah, that would be even better.
[AGENT][POSITIVE] I can do that right now for you if you'll bear with me just one second, I'll get that ready and then get that fax number and go ahead and send it right now.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It just takes me just a minute.
[CUSTOMER][NEUTRAL] Is a is a pre-authorization required or um recommended for SRP or it's fine?
[AGENT][NEUTRAL] It's not required.
[CUSTOMER][NEUTRAL] OK, so you cover it regardless.
[AGENT][NEUTRAL] If yes, if it's eligible for benefits we would cover without authorization.
[CUSTOMER][POSITIVE] Perfect, thank you.
[AGENT][NEUTRAL] And then so what?
[CUSTOMER][NEUTRAL] And the electronic payer IP is [PII].
[AGENT][NEUTRAL] It is.
[CUSTOMER][POSITIVE] Perfect, thank you.
[CUSTOMER][NEUTRAL] Go ahead, you were asking me something or fax number?
[AGENT][NEUTRAL] I was. What is that fax number?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Z.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And just to verify that fax number and she'll is I'm sending this to [PII], is that correct?
[CUSTOMER][NEUTRAL] Mhm, yes.
[AGENT][POSITIVE] All right, I just hit send so that is on the way for you. You should be receiving it shortly.
[CUSTOMER][POSITIVE] Sounds good. Um, anything that you would like me to tell you, any missing tooth claws apart from the waiting, now that the waiting period has ended?
[AGENT][NEUTRAL] Yeah, there is some missing tooth claws that is listed on the breakdown as well. Now the group name and number will not be listed and I can provide that if needed.
[CUSTOMER][NEUTRAL] Is it 15799 the group number and group voluntary dental, the group name?
[AGENT][NEUTRAL] The, the group voluntary dental is the type of policy, but I can give you the group name.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] The group name is Universal Trucking.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] US one logistics.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Sounds good thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Um, let me just check real quick.
[CUSTOMER][NEGATIVE] Um, uh, yes, I got fillings downgraded.
[AGENT][NEUTRAL] We don't downgrade.
[CUSTOMER][NEUTRAL] Oh no downgrades on crowns or nothing?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Oh wow, OK.
[CUSTOMER][NEUTRAL] And the breakdown is 18,040.
[AGENT][NEUTRAL] It is.
[CUSTOMER][POSITIVE] Perfect, anything else you think I should know?
[AGENT][NEUTRAL] On the fax back, you'll also get our payer ID claim submission address, and fax number. You can fax claims as well.
[CUSTOMER][NEUTRAL] OK, and we can send them electronically as well, right?
[AGENT][POSITIVE] Absolutely.
[CUSTOMER][POSITIVE] Perfect, sounds good thank you so much.
[AGENT][POSITIVE] It's been a pleasure to assist you, [PII]. Is there anything else I can help you with?
[CUSTOMER][POSITIVE] No, you're pretty good, thank you.
[AGENT][POSITIVE] All right. It's been my pleasure, and if you would also note all benefits given over the phone as a verification of coverage, not a guarantee of payment. You should be receiving that fax shortly, and it's been a pleasure to assist you [PII]h that breakdown, and I hope you have a wonderful day.
[CUSTOMER][POSITIVE] You as well thank you.
[AGENT][POSITIVE] Thank you bye bye.
[CUSTOMER][NEUTRAL] Yeah bye bye.