AccountId: 011433970860
ContactId: 88384fed-f465-4321-b218-d6dd7e328f6d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 395040 ms
Total Talk Time (AGENT): 152466 ms
Total Talk Time (CUSTOMER): 161938 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/22/88384fed-f465-4321-b218-d6dd7e328f6d_20250522T13:33_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Good morning [PII]. My name is [PII]. I'm calling from a provider's office. We're hoping to inquire upon some, uh, eligibility for a subscriber and a patient we have here.
[AGENT][NEUTRAL] All right, I'm happy to check on the eligibility today, [PII]. Can I get the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, so that's gonna be 023.
[CUSTOMER][NEUTRAL] 562-57
[AGENT][NEUTRAL] All right, thank you for that. And then if I could grab the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes ma'am, that's gonna be first name [PII], last name [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Thank you. So, patient is active. The effective date on the member's policy is [PII].
[CUSTOMER][NEUTRAL] Maybe
[CUSTOMER][POSITIVE] Thank you for that. And uh we're hoping to inquire upon uh dental benefits. Are we able to speak with you regarding that, ma'am?
[AGENT][NEUTRAL] Let me take a look here.
[AGENT][NEUTRAL] So the member's dental plan is actually a different policy number. Would you like to take that down?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Policy number for their dental is gonna be 02356209.
[AGENT][NEUTRAL] Same effective date of [PII].
[AGENT][POSITIVE] And we can absolutely give a verbal breakdown over the phone. We can also send a fax back with a breakdown of benefits, whatever works best.
[CUSTOMER][NEUTRAL] Thank you for that, ma'am. And so uh we were able to request a fax back on a separate phone call with a different uh representative. Uh, we did have some general questions just for instance, one moment.
[CUSTOMER][NEUTRAL] OK, was there gonna be any waiting periods associated with this policy we need to be aware of?
[AGENT][NEUTRAL] Uh, there is a 12 month waiting period. The members already satisfied that though. The waiting periods for major endoyio and oral surgery.
[CUSTOMER][NEUTRAL] Thank you for that, ma'am. And with a previous representative that we spoke with, for instance, they mentioned that the policy for dental coverage was active [PII]. Uh, are you able to verify that the waiting period is met?
[AGENT][NEUTRAL] Uh, well, that's for the member [PII]. You're checking for eligibility for Enrique, is that correct?
[CUSTOMER][NEUTRAL] Thank you for that, ma'am. Yes. And so uh we are also hoping to ask about [PII], but we did just want to clarify that so we do appreciate that. We'll go ahead and, uh, note down that for [PII], the 12 month waiting period is not met. Is that correct?
[AGENT][NEUTRAL] Correct, because, well, the effective date is for [PII], so it's actually been fulfilled at this point. They just both have a different effective dates.
[CUSTOMER][NEUTRAL] OK, thank you for that. uh, so just to verify then, um, so, so [PII]'s waiting period is also met as a result of, uh, the primary subscriber, is that correct, ma'am?
[AGENT][NEUTRAL] Uh, let me double check on that one moment.
[CUSTOMER][POSITIVE] Thank you for that, take your time.
[AGENT][NEUTRAL] All right. So just to confirm, the waiting period has been met for [PII]. It has not been met for [PII]. So [PII] is
[CUSTOMER][NEUTRAL] OK, thank you for that. So for her in her case it's gonna be until at least for major, that's correct um for major it'll be until [PII], correct?
[AGENT][NEGATIVE] Not been met.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, and this is only for major ma'am, um, is that correct?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] Thank you, ma'am. um, may we ask is there gonna be any fee schedule associated with this policy?
[AGENT][NEUTRAL] Uh, no, it looks like the plan just pays by UCR.
[CUSTOMER][NEUTRAL] Thank you for that. So, in that case, um, network won't be necessary if our doctors in or out of network.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, um, just a few moments.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and may we ask for the claims address please?
[AGENT][NEUTRAL] Absolutely, claims mailing address is going to be [PII], and that's at [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] In [PII].
[AGENT][NEUTRAL] And the zip code is going to be [PII].
[CUSTOMER][POSITIVE] Thank you for that just a few moments.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and are we able to send claims is that gonna be physically only or is it digital available or through fax?
[AGENT][NEUTRAL] Uh, we have fax and electronically both, which I can provide.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] Electronically our payer ID is 60801.
[AGENT][NEUTRAL] And then our fax number is gonna be [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][NEUTRAL] Thank you and who would we be addressing that to? Is it just gonna be claims department or?
[AGENT][NEUTRAL] Yes, just attention claims.
[CUSTOMER][NEUTRAL] OK, thank you for that. I believe it's gonna be the fullest extent of our questions for today. May we ask for a reference number please?
[AGENT][NEUTRAL] Absolutely. Call reference is my name with my last initial and then today's date. My name again is [PII], that's [PII] Last initial is gonna be [PII].
[CUSTOMER][POSITIVE] OK, greatly appreciate your assistance for today, ma'am. May we ask, is there any survey following the call that we can participate in?
[AGENT][POSITIVE] There is not, [PII], we appreciate you though. Is there anything else I can do for you?
[CUSTOMER][POSITIVE] That's all for today, ma'am. Once again, thank you for your assistance and have a nice day, ma'am. Goodbye.
[AGENT][NEUTRAL] You as well bye bye.