AccountId: 011433970860
ContactId: 9cdb4bfb-0e5f-499d-bcfd-062d4fba870d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 413940 ms
Total Talk Time (AGENT): 109489 ms
Total Talk Time (CUSTOMER): 132449 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/07/9cdb4bfb-0e5f-499d-bcfd-062d4fba870d_20250507T15:34_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from a provider's office looking to verify some dental benefits.
[AGENT][NEUTRAL] Hey Miss [PII], I can help you with dental benefits. May I please get your call back number and the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Yes, that's [PII] and it's Oral Surgery Associates.
[AGENT][NEUTRAL] OK, thank you. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] So it would be [PII] date of birth is [PII]. The member ID number that we were provided is 02346809.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, I do show that Xavion does have an active policy with us. The effective date of the policy is [PII].
[AGENT][NEUTRAL] And if you can give me your fax number I'll send you a fax back with this benefit breakdown and.
[AGENT][NEUTRAL] The schedule.
[CUSTOMER][NEUTRAL] OK, I can, OK, I can definitely give uh that information to you, the fax number when you're ready.
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] Is [PII].
[CUSTOMER][NEUTRAL] And if you can put attention [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, Ms. [PII] I'm gonna put you on a quick hold while I get this, uh huh, go ahead.
[CUSTOMER][NEUTRAL] And I
[CUSTOMER][NEUTRAL] Sorry, so, um, the phone is, it's not the best connection it's kind of cutting in and out a little bit on my end, um, you said so this will give us a breakdown of benefits as well as the fee schedule, is that correct?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] So are you able to at least confirm because just because we've never really worked with this plan, um, and I don't know if our office would be considered in or out of network.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] There's not a network they can use any provider they want to use.
[CUSTOMER][NEUTRAL] OK, so there's no contractual rates in terms of um a discount the the fee schedule that's sent is what the plan pays based on each individual fee, is that correct?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, OK, can you tell me, does medical need to be billed first for inactions such as wisdom teeth?
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] No ma'am, it's um based by uh procedure code that's on the fax back if the procedure code is not there then it's a noncovered service and then on each procedure code if there is a limitation like medical first it'll be on the fax back and it'll give you the limitations if there's any.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, OK, um, and on the fax back does it include a claims mailing address, payer ID, all of that information as to where the claims are sent to?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, and one other question I'm so sorry, does insurance payments come to us as the provider or those sent to the member?
[AGENT][NEUTRAL] It's OK.
[AGENT][NEUTRAL] It'll come to you if you're the one that's filing the claim.
[CUSTOMER][POSITIVE] Perfect. OK, just so that way we know OK, wonderful, um, if you, yeah, if you can go ahead and send that fax.
[AGENT][NEUTRAL] OK, I'm gonna put you on a quick hold while I get the fax ready and just as soon as I've got it on its way I'll get right back on the phone.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK all right thank you.
[AGENT][POSITIVE] Thank you, thank you for holding.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me, Miss [PII]. I do have that fax on its way to you now.
[CUSTOMER][POSITIVE] OK perfect and I'm so sorry what was your name?
[AGENT][NEUTRAL] My name is [PII], it's [PII]
[CUSTOMER][NEUTRAL] And are you able to provide a call reference number?
[AGENT][NEUTRAL] Yes ma'am, you can use my name and today's date.
[CUSTOMER][POSITIVE] All right wonderful thank you so much you have a good day.
[AGENT][POSITIVE] You too, Ms. [PII] you have a wonderful rest of your week and thanks for calling APL.
[CUSTOMER][NEUTRAL] Alright bye bye