AccountId: 011433970860
ContactId: 93982f59-923e-4595-a96d-df39f2889d6c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 543219 ms
Total Talk Time (AGENT): 233188 ms
Total Talk Time (CUSTOMER): 175963 ms
Interruptions: 2
Overall Sentiment: AGENT=0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/93982f59-923e-4595-a96d-df39f2889d6c_20250312T12:42_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from provider office looking for dental benefits.
[AGENT][NEUTRAL] I'm sorry, what was your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] I'm sorry, I can barely hear you.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK [PII], thank you, and your call back number?
[CUSTOMER][NEUTRAL] Yes, uh, call back [PII].
[AGENT][NEUTRAL] Thank you. And did you say that you were needing dental eligibility and benefit information?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, I, I can help you with that. Now, our dental policies, we have fax backs of the members' benefits that I will send to you that has all of their information on there.
[CUSTOMER][NEUTRAL] OK, uh, I have some specific.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] I'm sorry, what was your question?
[CUSTOMER][NEUTRAL] Yes, and please check uh provider is a network out of network and tell me the fees again.
[AGENT][NEUTRAL] I will be able to answer some of your questions once I can get the member's information pulled up because we have different types of policies [PII], what is the member's policy number?
[CUSTOMER][NEUTRAL] Yes, uh 02408611.
[AGENT][POSITIVE] Thank you, one moment.
[AGENT][NEUTRAL] OK. Repeat that number for me, please.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yes, 02408611.
[AGENT][NEUTRAL] OK, and any information provided would be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, ma'am. First name, [PII], and last name is [PII]. And date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. Now, the policy number that you provided for me is not the dental policy.
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] I need to give you a different, that's an incorrect policy number for the dental coverage, that is for the medical coverage.
[CUSTOMER][NEUTRAL] Just medical, ma'am, I have already eligibility, uh, last date of services, sir.
[AGENT][NEGATIVE] OK, did you, did you understand what I was explaining to you? The policy number that you provided for me is not correct.
[CUSTOMER][NEUTRAL] This
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, ma'am. This policy number is, please check, 024.
[CUSTOMER][NEUTRAL] 08546.
[AGENT][NEUTRAL] OK, that is the dental ID policy number.
[CUSTOMER][POSITIVE] OK, ma'am. Thank you.
[AGENT][NEUTRAL] That is the correct number you should have for dental. So just one moment, please.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so he is a subscriber on this policy and this policy is active with an effective date of [PII].
[AGENT][NEUTRAL] And you would ask about the network about the provider being a network. This is not a network plan.
[CUSTOMER][NEUTRAL] Uh.
[AGENT][NEUTRAL] They may choose any provider. Services are based, covered services are based on a percentage of the usual and customary charges of the service region. Again, this is not a network plan.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK. And provider is in-network and patient is out of network benefit.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] There is this is not a network plan, so I could not tell you because there is not a network they may choose any provider.
[CUSTOMER][NEUTRAL] What?
[CUSTOMER][NEUTRAL] Uh, uh, uh, any provider, OK.
[AGENT][NEUTRAL] And that information is stated on the fax back as well.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK. And ma'am, there is uh any waiting period and missing tooth loss?
[AGENT][NEGATIVE] There is. There is a missing tooth cloth and there is waiting period for certain categories which is included on the fax back.
[AGENT][NEUTRAL] It's 12 months for major endoperontic, prosthoontic, and oral surgery.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] 12 month wait.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It is mentioned in the faxed copy, right?
[AGENT][NEUTRAL] It is, yes, sir. Mhm.
[CUSTOMER][NEUTRAL] Uh, OK.
[CUSTOMER][NEUTRAL] And according to effective date and waiting period is certified.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, ma'am.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Um, this patient is out of network benefit and the schedule is a UCO.
[AGENT][NEGATIVE] Again, this is not a network plan so I can't say that he is out of network. He does not, he doesn't participate in a network.
[AGENT][NEUTRAL] This is not a network policy that he has.
[CUSTOMER][NEUTRAL] OK, ma'am. Can you send me the faxed copy of dental benefits?
[AGENT][POSITIVE] Yes, sir. I'll be happy to do that. Just one moment, please.
[AGENT][NEUTRAL] And will the facts need to be put to your attention, [PII], or is that not necessary?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Does it need to
[AGENT][NEUTRAL] Does the fax need to have your name on it also?
[CUSTOMER][NEUTRAL] My name is [PII]. I tell you fax number.
[AGENT][NEUTRAL] OK. Do I need to put the do I need to send the fax?
[AGENT][NEUTRAL] To your attention.
[AGENT][NEUTRAL] So that you can get it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Or do I just need to, OK, one moment.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And what is your fax number, please, [PII]?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I, I'm gonna repeat that back. [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so I have sent that to you now. Once if you will file a claim with APL once it has been processed by us, we do have a portal in which you can check our claim status and our portal website that you would go to for that is secured. [PII].
[CUSTOMER][NEUTRAL] OK, and uh.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Ma'am, uh, I have a code, but some code is not mentioned on the faxed copy percentage.
[AGENT][NEUTRAL] Uh, I'm sorry, I didn't understand what you said.
[CUSTOMER][NEUTRAL] Uh, I have got just need percentage.
[AGENT][NEUTRAL] All of the codes that are covered are listed on the fax back.
[CUSTOMER][NEUTRAL] Yes, it is listed, but uh OK. And
[AGENT][NEUTRAL] Uh-huh. And it also gives the limitations. Mhm.
[AGENT][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Yes, and the mention is uh uh limitation and uh services.
[CUSTOMER][NEUTRAL] But.
[CUSTOMER][NEUTRAL] OK. Thank you. What is your name?
[AGENT][NEUTRAL] Again, my name is [PII] and you would use my name along with today's date as your call reference number.
[CUSTOMER][POSITIVE] OK thanks.