AccountId: 011433970860
ContactId: 9e36fed3-73c9-43fa-8807-b94ce862b3f3
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 379140 ms
Total Talk Time (AGENT): 125873 ms
Total Talk Time (CUSTOMER): 118844 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/16/9e36fed3-73c9-43fa-8807-b94ce862b3f3_20250416T18:59_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey [PII], my name is [PII]. I'm calling with the dental provider's office. I'm trying to check eligibility and get benefits on the patient.
[AGENT][NEUTRAL] Of course, [PII], I can check eligibility and benefits. Do you have the patient's policy number?
[CUSTOMER][NEUTRAL] Um, uh, no, he just sent me a copy, a picture of the book. He didn't even know who he had, um, I have a social.
[AGENT][NEUTRAL] Uh
[AGENT][POSITIVE] OK, that'll work. I can look them up.
[CUSTOMER][NEUTRAL] OK, it's [PII].
[CUSTOMER][NEUTRAL] Actually, the only thing he sent me a picture of the book is like it is APL and it has like a [PII] and a phone number.
[AGENT][POSITIVE] Oh, wow.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yeah, that's not a lot.
[AGENT][NEUTRAL] OK. And then patient's first and last name and date of birth, please?
[CUSTOMER][NEUTRAL] Um, spell it, it's [PII] Last name is [PII], um, [PII].
[AGENT][POSITIVE] OK. Thank you.
[AGENT][NEUTRAL] OK, so it looks like this policy is active. The effective date is [PII].
[CUSTOMER][NEUTRAL] Oh, it's very new. OK, is it just a single or is it family? I thought probably just single.
[CUSTOMER][NEUTRAL] Sounds like he has his kids on there.
[AGENT][NEUTRAL] Yes, it's just single.
[CUSTOMER][NEUTRAL] Is there a group number I need to use?
[AGENT][NEUTRAL] Um, I do have the group number if you like it. It is.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] 70056.
[CUSTOMER][NEUTRAL] OK, and then um just a breakdown of benefits, please.
[AGENT][NEUTRAL] Yes, ma'am. Just one moment.
[AGENT][NEUTRAL] OK, so it looks like for.
[AGENT][NEGATIVE] Preventative expensive which is basic 100% of allowable.
[CUSTOMER][NEUTRAL] So this since we're out of network is this fee schedule or is it gonna be UCR?
[AGENT][NEUTRAL] Looks like, oh, I don't see this on the policy. Uh, just one moment.
[AGENT][NEUTRAL] This will be a fee schedule.
[CUSTOMER][POSITIVE] A free schedule. OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then I can also fax you.
[AGENT][NEUTRAL] Uh, the details of this, this, uh, policy.
[CUSTOMER][NEUTRAL] Yeah, that would be
[CUSTOMER][NEUTRAL] That would be great, yeah, does it tell you, um, is there missing who calls or waiting periods?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So this policy does have a missing tooth clause.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let me see.
[AGENT][NEUTRAL] I'm not seeing a waiting period.
[CUSTOMER][NEUTRAL] OK, if I tell you what we charge with the code is, can you tell me if we're in that lot amount?
[CUSTOMER][NEUTRAL] Do you have the fee schedule?
[AGENT][NEUTRAL] Yes, you can tell me what, so what are the codes that you have?
[CUSTOMER][NEUTRAL] I just, OK.
[CUSTOMER][NEUTRAL] Um, like a D10 I'm sorry, D0150.
[CUSTOMER][NEUTRAL] And then a D 0274.
[CUSTOMER][POSITIVE] That's what I'm gonna start off with because that's what we're gonna see him for um right off the bat.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[AGENT][NEUTRAL] OK, so the D0150.
[AGENT][NEUTRAL] Falls under preventative, which is 100% of allowable.
[AGENT][NEUTRAL] And this is limited to 2 oral evaluation procedures in any combination, per 12 month period.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK. And then,
[CUSTOMER][NEUTRAL] And then uh for the allowed amount we bill 78, do you know what that allowed amount is?
[AGENT][NEUTRAL] I don't. It just says 100% of allowable. Mhm.
[CUSTOMER][NEUTRAL] You don't? OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, alright then that's fine. um, yeah, can you fax me the benefits, the breakdown of benefits? That would be wonderful.
[AGENT][POSITIVE] Yeah, of course. I always recommend it because it's sometimes it's just easier for you to look at it then we say, OK, uh what is your fax number?
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Yeah, that'd be great.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, perfect. All right. And then I'll fax that over right now.
[CUSTOMER][POSITIVE] I appreciate it thank you.
[AGENT][POSITIVE] Of course, thank you. Have a good day. Thanks for calling APL.
[CUSTOMER][POSITIVE] You too thank you bye bye.
[AGENT][NEUTRAL] Mhm. Bye.