AccountId: 011433970860
ContactId: 9e35ccef-107f-4902-819d-f6dbeecf5176
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 682929 ms
Total Talk Time (AGENT): 216222 ms
Total Talk Time (CUSTOMER): 259424 ms
Interruptions: 4
Overall Sentiment: AGENT=0.7, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/9e35ccef-107f-4902-819d-f6dbeecf5176_20250331T17:41_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yes, hello Miss [PII]. My name is [PII], and I'm calling with the office of Doctor [PII]. How are you today?
[AGENT][POSITIVE] I'm doing well, Ms. [PII]. How are you doing today?
[CUSTOMER][POSITIVE] Excellent [PII], I do have um a question I was just calling to get a breakdown of benefits for an employee.
[AGENT][NEUTRAL] OK, I can help you with the benefits. Can I please get your callback number, Ms [PII], just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Yes ma'am, [PII].
[AGENT][NEUTRAL] Thank you. And then what's the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Her name is [PII] and her date of birth is [PII].
[AGENT][NEUTRAL] OK, and her policy number, please?
[CUSTOMER][NEUTRAL] Uh, I have 70,030.
[AGENT][NEUTRAL] OK, that looks like a group number. Do you see another number?
[AGENT][NEUTRAL] Let me try that real quick.
[CUSTOMER][NEUTRAL] Uh, she didn't. I only spoke with her. OK, no problem.
[AGENT][NEUTRAL] Um, yeah, that's a group number.
[AGENT][NEUTRAL] Do you see a number that starts with like a.
[CUSTOMER][NEUTRAL] I have an ID number.
[AGENT][NEUTRAL] What's that one?
[CUSTOMER][NEUTRAL] 02559646
[AGENT][POSITIVE] OK, that looks good. Let's look up that one.
[CUSTOMER][POSITIVE] OK fantastic.
[AGENT][NEUTRAL] OK, I do show that [PII] has an active policy and her effective date is [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And if you give me your fax number I can send you the complete benefit breakdown and fee schedule.
[CUSTOMER][POSITIVE] 00 that's awesome. OK, and this is we are considered an out of network provider. Will those would that the fee schedule still apply to that or would it be different?
[AGENT][NEUTRAL] Yes, ma'am.
[AGENT][NEUTRAL] It will because it goes by UCR.
[CUSTOMER][POSITIVE] Oh that's awesome. uh before you send me all that information, can I, will the mailing address and the payer ID be on that fax pack?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, and also, wait, do you show any history? Can I get that information from you?
[AGENT][NEUTRAL] Yes ma'am, do you?
[CUSTOMER][NEUTRAL] Like history for a full mouth series of X-ray?
[AGENT][NEUTRAL] Yes, ma'am, I can give you history. Um, let's see.
[AGENT][NEUTRAL] If she has any at all.
[CUSTOMER][NEUTRAL] We
[AGENT][NEUTRAL] She has never filed a claim on this policy, so there's no history.
[CUSTOMER][NEUTRAL] then.
[CUSTOMER][NEUTRAL] That was with me. I haven't got all morning. Oh.
[AGENT][NEUTRAL] Are you there?
[CUSTOMER][POSITIVE] I'm here. I'm so sorry.
[AGENT][NEUTRAL] Can you hear me? Oh, OK. No, that's OK. She's never filed. OK, good. She's never filed a claim on this policy, so there's no history of anything being paid.
[CUSTOMER][NEUTRAL] I I can hear you now. I can hear you.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Oh OK OK.
[CUSTOMER][NEUTRAL] OK, so can you tell me I'm gonna give you a couple of codes even though I know it'll probably come up there, but just for, uh, I'd like to know because sometimes they'll categorize the procedure code into a different category and I wanna make sure I'm on the same page so for core build up procedure code 2950, what is that covered at and.
[CUSTOMER][NEUTRAL] The frequency on that.
[AGENT][NEUTRAL] OK. And that will also be on, that will also be on your fax back. Um, let me pull that up real quick.
[CUSTOMER][NEUTRAL] And does the deductible apply?
[CUSTOMER][NEUTRAL] OK. OK.
[AGENT][NEUTRAL] OK, she has.
[AGENT][NEGATIVE] A no plan.
[AGENT][NEUTRAL] And what did you say that 2950 is?
[CUSTOMER][NEUTRAL] Uh, that is a core build up, a build up that goes with the crown.
[AGENT][NEUTRAL] Build up
[AGENT][NEUTRAL] OK, let me look.
[CUSTOMER][NEUTRAL] Uh huh.
[AGENT][NEUTRAL] OK, so she only has basic restorative.
[AGENT][NEUTRAL] On this policy and this is just to verify benefits. It's not a guarantee of payment. I do not see code 2950.
[CUSTOMER][NEUTRAL] OK, so that is not a covered benefit, so not a night guard or implants, so this is just for preventative and basic.
[AGENT][NEUTRAL] Um,
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Right, so.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Correct, so no major.
[AGENT][NEUTRAL] Correct. And when you, and when you get that fax back, if, if there's any uh codes that you're looking for that are not on the fax back, then it's not covered.
[CUSTOMER][NEUTRAL] No perio and uh.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] What is your um fax number?
[CUSTOMER][NEUTRAL] OK, so let.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] 13. OK, Ms. [PII], how do I spell your name?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Alright, let me put you on a quick hold. I'll get that fax ready for you and send it on over so you have everything that you need. It's gonna be a brief hold while I get it together, Miss Miss [PII] and I will come right back and let you know that I've sent it, OK? All right, thank you, ma'am.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and then I got a couple of questions just to ask you. OK, thank you.
[AGENT][NEUTRAL] Yes, that's fine.
[CUSTOMER][NEUTRAL] OK thanks. You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Oh, come on now.
[AGENT][NEUTRAL] Hi, Ms. [PII], this is [PII] back with you again. I've got that fax on its way to you now.
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] OK great OK so.
[CUSTOMER][NEUTRAL] For most cases, basic.
[CUSTOMER][NEUTRAL] It's
[CUSTOMER][NEUTRAL] Fillings, extractions.
[CUSTOMER][NEUTRAL] Some root canals I guess.
[CUSTOMER][NEUTRAL] And some they're not so they're in a category of their own so under the basic what is actually covered under basic ma'am?
[CUSTOMER][NEUTRAL] Would that just be fillings?
[AGENT][NEUTRAL] That will
[AGENT][NEUTRAL] There's many uh codes under basic that's on the fax back that'll show you everything that's covered um for this policy, and like I said, anything that's not on the fax back is a non-covered procedure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, so.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Now do you know for the fillings if they downgrade from a white composite to a so they do not, OK, OK. And can you let me know if this is a standard coordination of benefits, birthday rule or not duplicating.
[AGENT][NEGATIVE] No, they do not.
[AGENT][NEUTRAL] I'm sorry, can you repeat the question?
[CUSTOMER][NEUTRAL] Is this particular plan a standard coordination of benefits?
[CUSTOMER][NEUTRAL] It or does it go by the birthday rule or non duplicating?
[AGENT][NEUTRAL] It's um standard coordination of benefits uh it's paid by UCR.
[AGENT][NEUTRAL] And it's an annual that starts effective date, goes annually to the day.
[CUSTOMER][NEUTRAL] OK, and you do.
[CUSTOMER][NEUTRAL] OK, so there her effective date was [PII], so that's when her calendar year is, that's when her benefits reinstate in October or it starts from January to December, excuse me.
[AGENT][NEUTRAL] It
[AGENT][NEUTRAL] Effective date would restart again in October but she's not had a lapse in coverage um she's paid to date and the policy is still active.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Fantastic. Does this plan allow assignment of benefits?
[CUSTOMER][NEUTRAL] That payment go to the doctor?
[AGENT][NEUTRAL] Does the plan allow
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Assignment? OK.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK, some insurance companies don't. That's why I always ask, OK, and uh all the information, as you said, you show no history, so no pending claims. Can I get a reference number pertaining our call, Miss [PII]?
[AGENT][NEUTRAL] Mm, yeah.
[AGENT][POSITIVE] Absolutely, you can use my name, [PII], in today's date.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much you've been so helpful I really appreciate you you have a great rest of your day, OK? OK, bye bye.
[AGENT][POSITIVE] You're very welcome.
[AGENT][POSITIVE] You too, Ms. [PII]. Thank you for calling APL. Bye-bye, ma'am.
[CUSTOMER][POSITIVE] You got you take care bye bye.