AccountId: 011433970860
ContactId: 96007ea5-6480-4dae-b504-1919aaf0e7ba
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 447920 ms
Total Talk Time (AGENT): 163887 ms
Total Talk Time (CUSTOMER): 92056 ms
Interruptions: 2
Overall Sentiment: AGENT=0.2, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/96007ea5-6480-4dae-b504-1919aaf0e7ba_20250122T18:25_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], I have a couple of questions about my patient's policy.
[AGENT][NEUTRAL] OK, you have questions regarding your patient's policy? Are you needing benefit information?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][POSITIVE] Yes, I can help you with that. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] Thank you and [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Did you say [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Thank you and [PII], what is your patient's policy number?
[CUSTOMER][NEUTRAL] 012553772
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 012553772. Is that correct?
[CUSTOMER][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] OK, thank you. One moment please.
[AGENT][NEUTRAL] Just one moment, [PII].
[AGENT][NEUTRAL] OK, and any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] My goal is [PII].
[AGENT][POSITIVE] OK, so how can I help you today? Thank you.
[CUSTOMER][NEUTRAL] Can I get the group number and the group name?
[AGENT][NEUTRAL] Mhm. The group number is 18528.
[AGENT][NEUTRAL] The group name is pretty long, Universal Trucking.
[AGENT][NEUTRAL] United.
[AGENT][NEUTRAL] Petroleum
[AGENT][NEUTRAL] Transport.
[CUSTOMER][NEUTRAL] OK. And then can you tell me, does he still have all of his benefits?
[AGENT][NEUTRAL] One moment.
[AGENT][NEGATIVE] As of now, he has, there have not been any benefits used for this calendar year.
[CUSTOMER][NEUTRAL] Does prevent it apply to the maximum?
[AGENT][NEUTRAL] It does not. Um, you did receive your fax back. I can see that someone sent that to you.
[CUSTOMER][NEUTRAL] Yes, I did.
[AGENT][NEUTRAL] Yes, and that's covered at 100% of the UCR.
[AGENT][NEGATIVE] And anything not on the fax back [PII] is not covered.
[CUSTOMER][NEUTRAL] And then can I get
[CUSTOMER][NEUTRAL] OK. Can I get history for him?
[AGENT][NEUTRAL] OK, what's the first code you would like checked?
[CUSTOMER][NEUTRAL] 0120.
[AGENT][NEUTRAL] 731 of 19.
[CUSTOMER][NEUTRAL] OK. 11:10.
[AGENT][NEUTRAL] 11:15, 24.
[CUSTOMER][NEUTRAL] 0274.
[AGENT][NEUTRAL] 1115 24.
[CUSTOMER][NEUTRAL] 0330.
[AGENT][NEUTRAL] 1115 24.
[CUSTOMER][NEUTRAL] OK. And can you tell me what the healing period between SRP and perial maintenance is?
[AGENT][NEUTRAL] What the healing period is? Is that correct?
[CUSTOMER][NEUTRAL] Yes ma'am. How long you, yeah, how long you have to wait to do period maintenance after the SRP?
[AGENT][NEUTRAL] Do you have codes for that?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] The SRP code is 4341 and the 4910.
[AGENT][NEUTRAL] OK, let's
[AGENT][NEUTRAL] OK, it just shows uh for the 4910, it's a maximum of 1 procedure for 6 months. And then you said the other code was 4341, is that correct?
[CUSTOMER][NEUTRAL] Yes sir.
[AGENT][NEUTRAL] And on the limitation for that, it shows maximum 1 each quadrant for 24 months.
[AGENT][NEUTRAL] And that is on the very, the limitations are on the very last page, [PII].
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] Of the fax back.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, let me see one other thing. Let me make sure, see if I can find it on the text too, but I was, I didn't see that there was any downgrades just off of the limitation codes, but OK, I just wanted to make sure.
[AGENT][NEUTRAL] There's not.
[CUSTOMER][POSITIVE] OK, I think that's all I needed.
[AGENT][NEUTRAL] Uh-huh, sure.
[AGENT][NEUTRAL] OK, that's all.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] OK, well, if that's all then, [PII], that I can help you with. Thank you again for calling APL and I hope that you have a very nice afternoon.
[CUSTOMER][POSITIVE] You too. Thank you.
[AGENT][NEUTRAL] You're very welcome. Oh, and one last thing, [PII], [PII], one last thing, I don't know if the representative you spoke to before told you about our portal.
[CUSTOMER][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] But once the claim has been processed with APL, they didn't. OK, once the claim has been processed with APL, we do have a portal in which you should be able to access claim status and also the explanation of benefits and our portal website is secured.
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Perfect. Thank you very much.
[AGENT][POSITIVE] OK, you're very welcome. So have a great afternoon.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.