AccountId: 011433970860
ContactId: 8aafb9f4-811b-4391-bed3-ea2f7c2f0314
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1590469 ms
Total Talk Time (AGENT): 200982 ms
Total Talk Time (CUSTOMER): 211107 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=-1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/04/8aafb9f4-811b-4391-bed3-ea2f7c2f0314_20250204T21:49_UTC.wav
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[AGENT][POSITIVE] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], um, my name's [PII]. I have gotten to talk to a whole bunch of people there today, um, requesting faxes, and I am not receiving them, but I have a patient coming in at [PII] tomorrow morning and I'm needing some benefits.
[AGENT][NEUTRAL] OK. Um, I could try to fax it to you again and I can remain on the line until you receive it.
[CUSTOMER][NEUTRAL] OK, um, are you not able to give them verbally if if it's not coming through?
[AGENT][POSITIVE] Um, yes, ma'am. I can get benefit.
[CUSTOMER][NEUTRAL] I mean we can try that but.
[AGENT][NEUTRAL] OK, let's see if I can get the fax sent to you first. What's your fax number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] And that's attention, [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK. And could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] And the member's policy number, please?
[CUSTOMER][NEUTRAL] 01246519 for [PII].
[AGENT][NEUTRAL] OK. And please verify her date of birth.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] OK, so that's attention, [PII] [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, I just sent it and I'm gonna place you on a brief hold if you don't mind holding.
[CUSTOMER][NEUTRAL] OK, not at all.
[AGENT][NEUTRAL] OK. Thank you. OK, thank you. One moment.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, [PII], thanks for your patience. Um, have you received the fax yet?
[CUSTOMER][NEUTRAL] I have not.
[AGENT][NEUTRAL] OK. Well, I can assist you over the phone. Um, just let me advise you the verification of coverage does not guarantee payment of claims. Um, I'm showing the effective date on this policy was [PII]. The policy is still active. And um, which benefits do you need to verify? Is there a particular code you need me to look up or?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Well, is there in or out of network?
[CUSTOMER][NEUTRAL] On this
[AGENT][NEUTRAL] OK, I'm showing that
[CUSTOMER][NEUTRAL] But then I do have some specific codes.
[AGENT][NEUTRAL] Yeah, I'm showing that under this policy, there's no network. We work with all providers.
[CUSTOMER][NEUTRAL] OK, so it's just a percentage and then is it based on like reasonable and customary?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] So the first code is 0140.
[AGENT][POSITIVE] OK, that's good.
[AGENT][NEUTRAL] Yes, I'm showing that it's um under the usual and customary, 80% with no waiting period.
[CUSTOMER][NEUTRAL] OK, is there a frequency on that?
[AGENT][NEUTRAL] No, I'm not showing any.
[CUSTOMER][NEUTRAL] OK, um, and is it covered on the same day as treatment?
[AGENT][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] The next code is 0220.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, I'm showing that that's also at 80% usual and customary, um, with no waiting period.
[CUSTOMER][NEUTRAL] OK, um, I have a few more codes, but usual and customary if I give you our office fee, are you able to tell me if it's within your allowed amount?
[CUSTOMER][NEUTRAL] Or what those allowed amounts are?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Well, I can look up the code and see. All of them don't have the loud amount, but yeah.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, um, do you wanna go ahead and finish percentages and then do that all at once or what would you prefer to do? OK, um, the next code is 0364.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, that one isn't.
[CUSTOMER][NEUTRAL] Is your voice out today?
[AGENT][NEUTRAL] Yeah, this one isn't coming up on a fee schedule. You said 0364?
[CUSTOMER][NEUTRAL] Yes, the cone beam imaging.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] 362.
[CUSTOMER][NEUTRAL] It's not covered by a lot of plans, so.
[AGENT][NEGATIVE] Yeah, it's not coming up.
[CUSTOMER][NEUTRAL] OK, that's all right, um, the next one is 0460.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] It's another basic expense, 80% with no waiting period.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and then the next one is 3320.
[AGENT][NEUTRAL] OK, I'm showing 40%. There's a 12 month waiting period.
[AGENT][NEUTRAL] And I think.
[CUSTOMER][NEUTRAL] OK, but she would have met that, right? Because you said effective since [PII]?
[AGENT][MIXED] That's correct. But I think there's one more limitation. One moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, that doesn't apply to this one. OK.
[CUSTOMER][NEUTRAL] OK, um.
[AGENT][NEUTRAL] And what was
[CUSTOMER][NEUTRAL] And then the last code I have is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, 80% but no waiting period.
[CUSTOMER][NEUTRAL] OK, um, and then are you able to um.
[CUSTOMER][NEUTRAL] Help with those reasonable and customary.
[CUSTOMER][NEUTRAL] Amounts
[AGENT][NEUTRAL] Let's see, actually, there are no amounts on here.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] So you're not able to give us any any information on the fees that those are based on?
[AGENT][NEUTRAL] Right, let's see.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Yeah, the covered services are just based on the percentage of the usual and customary charges.
[CUSTOMER][NEUTRAL] OK, um, and is there a maximum deductible on this account?
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, yes, the calendar year maximum is $1500 per calendar year, and the, the deductible is $50 and I can see if she's met anything yet.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Um, no, she hasn't met anything so far this year.
[CUSTOMER][NEUTRAL] OK, and it is calendar year?
[AGENT][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] OK, um, and then the usual and customary is that based on a certain like networks like Deimmax or Carrington or something like that fee schedule or?
[AGENT][NEUTRAL] Carrington.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] All right. I, uh appreciate all your help um and you said your name was [PII]?
[AGENT][NEUTRAL] Yes, ma'am. [PII]. My last initial is [PII].
[CUSTOMER][NEUTRAL] All right
[CUSTOMER][POSITIVE] OK, thanks so much I appreciate your help.
[AGENT][NEUTRAL] OK. Is there anything else that I can assist you with?
[CUSTOMER][NEUTRAL] That is all thank you so much. Oh, I'm sorry, I do, I do have one more thing, [PII], um, I need a claims address and a payer ID.
[AGENT][POSITIVE] Yeah, thank you again.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Our payer ID is 60801.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the mailing address is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And please attention it to the claims department.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that's at [PII].
[CUSTOMER][NEUTRAL] [PII] OK.
[AGENT][NEUTRAL] Mhm. [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] All right thank you so much have a good night.
[AGENT][NEUTRAL] You do the same, [PII]. Thank you for calling APL. Mm bye.
[CUSTOMER][POSITIVE] Thanks bye bye.