AccountId: 011433970860
ContactId: 929b2e43-ae49-4d86-ae38-060eb3610a3f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 303799 ms
Total Talk Time (AGENT): 134232 ms
Total Talk Time (CUSTOMER): 99876 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/929b2e43-ae49-4d86-ae38-060eb3610a3f_20250424T15:30_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes ma'am, I was verifying, uh, I, I'm calling from a provider's office trying to verify eligibility and history for a patient.
[AGENT][NEUTRAL] Yeah, I can check eligibility and history for you. Um, what was your name?
[CUSTOMER][NEUTRAL] Yes ma'am [PII].
[AGENT][NEUTRAL] OK, [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes ma'am, [PII].
[AGENT][NEUTRAL] Thank you. And then can I get a policy number, please?
[CUSTOMER][NEUTRAL] Uh yes ma'am, it is.
[CUSTOMER][NEUTRAL] 01735036
[AGENT][NEUTRAL] OK and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] Yes, [PII] [PII].
[AGENT][POSITIVE] Perfect, thank you for verifying that. Uh, so this policy is active. Effective date was [PII].
[AGENT][NEUTRAL] And give me one moment, let me take a look at that history.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so last history I have on file for this number was from [PII].
[AGENT][NEUTRAL] So was there anything in particular we're looking for?
[CUSTOMER][NEUTRAL] If it makes our panel please.
[AGENT][NEUTRAL] OK, uh, could you give me those codes?
[CUSTOMER][NEUTRAL] Yeah, [PII] 10 or [PII] please?
[AGENT][POSITIVE] OK, thank you one moment.
[AGENT][NEUTRAL] OK, so [PII].
[AGENT][NEUTRAL] That was
[AGENT][NEUTRAL] Let's see, [PII].
[AGENT][NEUTRAL] And that is you don't have much.
[CUSTOMER][NEUTRAL] [PII], I'm sorry, [PII].
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] And that's the only one I have for this.
[CUSTOMER][NEUTRAL] And what mhm.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the [PII] no history?
[AGENT][NEUTRAL] Uh, right.
[CUSTOMER][NEUTRAL] And so no benefits have been used for this year?
[AGENT][NEUTRAL] None have been used for this number. The most I have is from [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]? OK, was that [PII]?
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK ma'am, can I have a fax back all the benefits please?
[AGENT][POSITIVE] Absolutely, uh, what was that fax number for you?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, I'm gonna read that back to make sure I heard that correctly. That was [PII]?
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK, I will go ahead and get that sent now. I should get it within about 10 minutes or so. Was there anything else I could help you with, Genesis?
[CUSTOMER][NEUTRAL] Yes, uh, could I verify the group number I have here 18528?
[AGENT][POSITIVE] Let's see. Yes, that's correct.
[CUSTOMER][NEUTRAL] And right now the co-insurances that we have here is 100 uh 140.
[CUSTOMER][NEUTRAL] Let me see, 18,040.
[AGENT][NEUTRAL] Yes, that's right, uh, 100 for preventative, 80 for basic and radiographs, and then, uh, all major is going to be at 40.
[CUSTOMER][NEUTRAL] And I'm sorry, you said 80 for radiographs?
[AGENT][NEUTRAL] Correct, uh, radiographs and FMX.
[CUSTOMER][NEUTRAL] Oh, the PA.
[CUSTOMER][NEUTRAL] Oh, OK, what about the panel, the panoramic?
[AGENT][NEUTRAL] Uh, yes, that falls under the same, the 80%.
[CUSTOMER][NEUTRAL] OK, the bite wings, is that under 80?
[AGENT][NEUTRAL] I believe that's preventative. Let me see.
[CUSTOMER][NEUTRAL] Oh OK.
[AGENT][NEUTRAL] Yes, that's going to be under preventative, so 100%.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK ma'am, and the restorative, uh, is that under 80 or 40?
[CUSTOMER][NEUTRAL] Basic or major?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] What was that code if you don't mind?
[CUSTOMER][NEUTRAL] 2391 2392.
[AGENT][NEUTRAL] OK, uh, yes, so that is basic, so 80%.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK ma'am, and the maximum I have here is 1500.
[AGENT][NEUTRAL] Correct, uh, $50 deductible that does not apply to preventative expenses.
[CUSTOMER][NEUTRAL] OK ma'am, OK, and I'll go ahead and wait for that fax. May I have your name and a reference number?
[AGENT][NEUTRAL] Alright, yeah, uh, reference number would just be my first name, last initial, and today's date. Uh, so my name is spelled [PII] Last initial is [PII] Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] No ma'am, that'll be all.
[AGENT][POSITIVE] Alright well thanks for giving us a call. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you so much you too.
[AGENT][POSITIVE] Thank you bye bye.
[CUSTOMER][POSITIVE] Thank you bye bye.