AccountId: 011433970860
ContactId: 9b8d3714-36ad-4b1a-af00-ac640b877232
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 361779 ms
Total Talk Time (AGENT): 140159 ms
Total Talk Time (CUSTOMER): 161439 ms
Interruptions: 2
Overall Sentiment: AGENT=0.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/15/9b8d3714-36ad-4b1a-af00-ac640b877232_20250515T19:50_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling you on behalf of provider's office to check on eligibility and benefits for a patient today. Can you assist me with that on a recorded line?
[AGENT][NEUTRAL] I can help you, [PII] and you said that you're checking for.
[CUSTOMER][NEUTRAL] Eligibility and benefits for a patient.
[AGENT][NEUTRAL] OK, is this, is this for service in an office setting or is it outpatient or inpatient?
[CUSTOMER][NEUTRAL] Uh, it's for Spe Dental office.
[AGENT][NEUTRAL] Oh, it's a dental provider, OK, what's the policy number?
[CUSTOMER][NEUTRAL] Sure, the policy number for the number I have is 02269758.
[AGENT][NEUTRAL] What's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure, callback number is [PII].
[AGENT][NEUTRAL] Thank you. What's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Patient's name is [PII] The last name is [PII], and I'll just spell it out, the last name to you. It's [PII], and the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] Mhm. You're welcome.
[AGENT][NEUTRAL] So I'm showing that the policy effective date is [PII].
[CUSTOMER][NEUTRAL] uh provide.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm showing the policy is active.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] And do you want the schedule of benefits?
[CUSTOMER][NEUTRAL] OK. So may I get the
[AGENT][NEUTRAL] Faxed over to you.
[CUSTOMER][NEUTRAL] Yes, go ahead. Sure, no problem. You can fax it on [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] OK, so on the fax back, um, it will include the calendar year maximum and deductible information, uh, the common limitations exclusions, um, it will list each procedure code that's covered by the policy, so if you don't see it on there, that means it's not covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, it'll give you the percentage level, so preventive.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, is 100% basic is 80, major is 40.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, they've exceeded the 12 month waiting period for, for major services.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let's see.
[CUSTOMER][NEUTRAL] Is there any waiting period or missing tooth cloth on the plan for this patient?
[AGENT][NEUTRAL] You know, the exclusions are listed, which missing tooth clauses is listed, is it, it's um does have a missing tooth clause, and I was stating earlier that he has uh satisfied the 12 month waiting period. So there is a 12 month waiting period for major, but he was effective in [PII], so that no longer applies.
[CUSTOMER][POSITIVE] Exactly
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so it's
[CUSTOMER][NEUTRAL] OK. And group name and group number will be available in the fax?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It will not. Do you have a copy of the card?
[CUSTOMER][NEUTRAL] No, I don't have a copy of the card. You can provide me on call.
[AGENT][NEUTRAL] And the, the group number?
[AGENT][NEUTRAL] The group number is 14564.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the group name is Universal Trucking.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Universal
[AGENT][NEUTRAL] Trucking
[CUSTOMER][NEUTRAL] Trucking. OK. And it's a single coverage plan, right?
[AGENT][NEUTRAL] Uh, it is not. I'm showing.
[AGENT][NEUTRAL] Couple coverage.
[CUSTOMER][NEUTRAL] The family.
[AGENT][NEUTRAL] Couple
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Couple coverage. OK. So, uh, may I know which uh the schedule the provider will be following?
[AGENT][NEUTRAL] It's based on usual customary and reasonable rates, so UCR.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK. UCR.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So this all details will be uh there in um
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] I'm sorry, what was the question?
[CUSTOMER][NEUTRAL] The details which you are providing me the question was the fee schedule will be provided in the um fax.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It is.
[CUSTOMER][NEUTRAL] So it will be available. OK. So may I know the claim mailing address and then um we'll be waiting for the fax.
[AGENT][NEUTRAL] Yeah, the claims mailing address, fax number and payer ID number is on the schedule of benefits that I'm faxing over to you.
[CUSTOMER][NEUTRAL] OK, no problem. So I'll be waiting for that. So what will be the expected time for the fax?
[AGENT][NEUTRAL] I just sent it to you to fax number [PII], so you should be receiving it shortly. And did you have any other questions, [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, sure.
[CUSTOMER][NEUTRAL] No, I don't have no more questions. So, can I get your name and the caller reference number for this call?
[AGENT][NEUTRAL] You'll use my name in today's date as reference for today's call [PII].
[AGENT][NEUTRAL] [PII] initial [PII] name is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] So thank you for giving your valuable time. Have a nice day.
[AGENT][POSITIVE] Oh, you're welcome thanks for calling APL have a good day.
[CUSTOMER][POSITIVE] Have a good day. Be safe. Bye-bye.
[AGENT][NEUTRAL] You too.
[CUSTOMER][NEUTRAL] Mhm.