AccountId: 011433970860
ContactId: 95fcd217-78aa-4e76-87ca-56766e7f55ad
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 422049 ms
Total Talk Time (AGENT): 144418 ms
Total Talk Time (CUSTOMER): 122196 ms
Interruptions: 0
Overall Sentiment: AGENT=1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/09/95fcd217-78aa-4e76-87ca-56766e7f55ad_20250509T17:15_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Oh yes, good afternoon, [PII]. My name is [PII] and I'm with the provider. I wanted to go ahead and check eligibility for a patient.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the eligibility. And [PII], may I have a good contact number in case we're disconnected and the policy number?
[CUSTOMER][NEUTRAL] Yes, that would be [PII] and the policy number is um 02273439.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Uh, yes, that would be, uh, [PII] with date of birth.
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment, and you said you needed the eligibility, correct?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yes, I just wanted to see if you know, um, her policy is still active and see if she will be eligible for the preventative service, um, the exam along with the X-rays and the cleaning.
[AGENT][NEUTRAL] So the policy is active, it's been effective since [PII]. And let me see, hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And do you mind if I place you on just a brief hold? I'm just pulling up the facts back.
[CUSTOMER][NEUTRAL] Sure, yeah, sure.
[AGENT][POSITIVE] Thank you. Hold on one moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] All right, thank you so much for holding. I do apologize for that wait. Um, so for the history, do you have particular codes that you'd like me to look at? I, I can't, OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Yes, I would.
[CUSTOMER][NEUTRAL] OK. Yeah. Uh, do you want all at once or just one by one?
[AGENT][POSITIVE] All at once is fine.
[CUSTOMER][NEUTRAL] OK. So I might, I'll need for that D 0120, 0274, D 0220, D 0230, and the uh D 1110. Those are the codes that I need. Mhm.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] For 120 or 0 120, the last day of service is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For, go to the next 1. 00274, last day of service was [PII].
[CUSTOMER][NEUTRAL] Mhm, so she's good for that, right? because that one was 1 every 12 consecutive months.
[AGENT][NEUTRAL] Um, let me, hold on one second, let me go to the fax bag.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes, it's one for 12-month period. So, uh, [PII], she was, she became eligible.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then
[CUSTOMER][NEUTRAL] And then, you know, for that, we say for the um D0120, you say that last one was [PII]. So did you will be eligible as of right now for uh another exam.
[CUSTOMER][NEUTRAL] On [PII], did she be eligible?
[AGENT][NEUTRAL] Let me see, hold on one moment.
[CUSTOMER][NEUTRAL] Oh, it have to be exactly the 6 months plus 1 day.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The or the
[AGENT][NEUTRAL] Early evaluations are um 2 for 12 month period. So the last time she had it was in November, December, January, Feb, March, April, May.
[AGENT][NEUTRAL] So [PII] will be 6 months from when she had it.
[AGENT][NEUTRAL] Last
[CUSTOMER][NEUTRAL] Oh OK, OK.
[CUSTOMER][POSITIVE] So she's good, right? We don't have to get that extra day?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] What do you mean extra day? Janu so for November?
[CUSTOMER][NEUTRAL] You know how sometimes, yeah, sometimes, mhm.
[AGENT][NEUTRAL] She can wait that day.
[CUSTOMER][NEUTRAL] And sometimes they required to be that the 6 months plus 1 day.
[AGENT][NEUTRAL] Oh no, this policy doesn't specify that. It's just per 12 month period, so from day to day.
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][NEUTRAL] OK, got it. Mhm.
[AGENT][NEUTRAL] OK, and I think we were on 00274.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so that last day of service was [PII]?
[CUSTOMER][NEUTRAL] Mm.
[AGENT][NEUTRAL] So, um, that's now eligible. Um, let me go to the next one.
[AGENT][NEUTRAL] 00220. Last day of service is [PII].
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] 00230 was also [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then,
[AGENT][NEUTRAL] 1110 was January, I'm sorry, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So she's good for that, right?
[AGENT][NEUTRAL] Right, trophies are once every 6 months.
[CUSTOMER][NEUTRAL] OK, that's what I wanted to know.
[AGENT][NEUTRAL] Alright, well, was there anything else I could assist you with today, [PII]?
[CUSTOMER][POSITIVE] No, that was it. Thank you so much.
[AGENT][POSITIVE] You're welcome and thanks for calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.