AccountId: 011433970860
ContactId: a39a2cf8-bf38-4baa-9b75-28f72c5c88f4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 671979 ms
Total Talk Time (AGENT): 230510 ms
Total Talk Time (CUSTOMER): 372586 ms
Interruptions: 2
Overall Sentiment: AGENT=1, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/a39a2cf8-bf38-4baa-9b75-28f72c5c88f4_20250124T21:05_UTC.wav
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[AGENT][NEUTRAL] For contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] and I'm calling from a dental provider office. I'd like to ask some questions with regards to patients eligibility. Would you please help me with that?
[AGENT][NEUTRAL] Yes, I can help with eligibility and what is that policy number, please?
[CUSTOMER][NEUTRAL] Yes, it is 0227.
[CUSTOMER][NEUTRAL] 343 9.
[AGENT][NEUTRAL] Thank you, and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Yes. Uh, first name is [PII].
[CUSTOMER][NEUTRAL] Yes, spelled as [PII] And last name is [PII], spelled as [PII] And date of birth is [PII].
[AGENT][POSITIVE] Thank you. And if I could have a callback number, please, in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Oh yes. Uh my contact number is [PII].
[AGENT][POSITIVE] Thank you. I appreciate that. The policy went into effect on [PII] and uh Mr. [PII] is active. Now you mentioned that you wanted to know about the eligibility. Is there anything else besides that that I can help with?
[CUSTOMER][NEUTRAL] Yeah, um, I think we can save time, uh, on that because we did the breakdown for the patients back in January January last year, so I would like to know whether there's any changes to the plan that we verified last year or does everything stay the same?
[AGENT][NEUTRAL] Uh, everything is exactly the same. Nothing has changed at all.
[CUSTOMER][NEUTRAL] Oh great. Oh, OK, great. So I would like to reconfirm that the group number is 25023, right?
[AGENT][NEUTRAL] Uh yes. Um, let's just see here. OK, so the, yes, the uh group number is 25023. That is correct.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Oh, OK. And then, uh, let me see. Um, may I confirm that the claim address is [PII] [PII] City, um, and, uh, [PII], and the zip code is [PII].
[AGENT][POSITIVE] That's correct, yes, that is correct.
[CUSTOMER][NEUTRAL] Is that correct?
[CUSTOMER][NEUTRAL] Yes, and yes, and the electronic ID is 60801.
[AGENT][NEUTRAL] Yes, that's true.
[CUSTOMER][NEUTRAL] Oh, OK. And then let me see if there is anything else I would like to reconfirm. Uh, OK. And for the plan, it is $1500 per calendar year with a $50 deductible.
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][NEGATIVE] In uh nothing has been used, nothing has been met.
[AGENT][NEUTRAL] Not, not for [PII]. That's right.
[CUSTOMER][NEUTRAL] Oh, OK, great. And uh preventative for for us as our network dentist, preventative will be covered at 100%, basic at 80%, and measure at 40%. Is that correct?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, no orthodontic coverage.
[AGENT][POSITIVE] That's right.
[CUSTOMER][NEUTRAL] Yes, and, uh, exam, um, the regular exam would be 2 times for 12 months and property is once every 6 months.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, great. And uh also I would like to confirm that there is a missing tooth cloth and you pay unseated.
[AGENT][NEUTRAL] Yeah
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][NEUTRAL] Oh, OK, great and then um.
[CUSTOMER][NEUTRAL] I'm looking for um.
[CUSTOMER][NEUTRAL] Two more additional codes that I didn't hit last year, so would you be, uh, I want to check that for me?
[AGENT][NEUTRAL] Yes, what's the first code, please?
[CUSTOMER][NEUTRAL] Yes, so it is 9910.
[CUSTOMER][NEUTRAL] And uh the next one is 4346.
[CUSTOMER][NEUTRAL] I would like to know the coverage percentage and frequency, please.
[AGENT][NEUTRAL] 9910 isn't covered and you said the other one is 4346?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Still checking?
[CUSTOMER][POSITIVE] Yes please thank you.
[AGENT][NEGATIVE] That is not covered.
[CUSTOMER][NEUTRAL] 0. 4346 not covered?
[AGENT][NEUTRAL] Um, no, I don't show that that is covered.
[CUSTOMER][NEUTRAL] Oh, OK. So I'm sorry, what about 19,910?
[AGENT][NEUTRAL] I'm not showing that, um, I'm not seeing 9910. I'll check again.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] So probably not covered either.
[AGENT][NEUTRAL] No, I don't.
[AGENT][NEGATIVE] No, it's not covered.
[CUSTOMER][NEUTRAL] OK, great, thank you and uh let me see if there's anything else I want to oh OK. I have a question regarding fillings so let's check the code uh 2391. I would like to know if it is downgraded for models.
[AGENT][NEGATIVE] Uh, no, it is not.
[CUSTOMER][NEUTRAL] OK, so filling know that with. OK, thank you very much for that. And then I just would like to reconfirm that implants and related services are not covered. Is that correct?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, great. Thank you so much for that. So, um, it's only clear about eligibility, so no further question about eligibility to ask. Uh, but I would like to follow up with a claim for the same patient that we submitted on [PII]. And according to our record, it hasn't been paid. So can you please take a look for me?
[AGENT][NEUTRAL] Yes, what is the date of service, please?
[CUSTOMER][NEUTRAL] Yes, it's [PII] for a total of $800.
[AGENT][NEUTRAL] OK, excuse me, just one moment please.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] OK, it looks like the uh claim number for this.
[AGENT][NEUTRAL] It's 35.
[CUSTOMER][NEUTRAL] 35
[AGENT][NEUTRAL] 11
[AGENT][NEUTRAL] 283.
[CUSTOMER][NEUTRAL] 11
[CUSTOMER][NEUTRAL] 283.
[AGENT][NEUTRAL] OK, so that looks like that.
[AGENT][NEUTRAL] Was processed, um.
[AGENT][NEUTRAL] On [PII].
[AGENT][NEUTRAL] 27. It looks like at that time, a check.
[CUSTOMER][NEUTRAL] To.
[AGENT][NEUTRAL] Uh, in the amount of $38 with um issued and uh.
[AGENT][NEUTRAL] 781. So it looks like that check went to [PII].
[CUSTOMER][NEUTRAL] Yes. So you said $38?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Oh, let me see.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Do you know why it is only $38?
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Yes, some of the uh charges, um,
[AGENT][NEUTRAL] Uh, there are some, uh, charges, uh such as uh 01330 that was not covered, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And let's see what else there was, uh.
[AGENT][NEUTRAL] Uh, the, uh, fluoride is covered every 12 months and it's limited to patients 19 and under. So the fluoride is not covered, that's 01208.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. OK, I understand. Yes.
[CUSTOMER][NEUTRAL] But how much is paid for uh proper 1110 and 0274?
[AGENT][NEUTRAL] 11 $10 that was $38. Um, and then what was the other one? What was the other?
[CUSTOMER][NEUTRAL] Uh, the other one is 0274.
[AGENT][NEUTRAL] Service
[AGENT][NEUTRAL] OK. 0274, um, that one that, uh, once we had paid for the uh for the trophy, once we pay that $38 for the trophy, all of his benefits have been used. So it's covered, but all of the benefits have been used.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, it doesn't mean that the patient maxed out, right?
[AGENT][NEUTRAL] No, it doesn't mean that at all. It just means that it means that he maxed out his, his benefits. He maxed out his benefits, that's that everything else was uh um.
[CUSTOMER][NEUTRAL] Uh,
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Oh, OK. What, what about, what about exam? So we have another code uh 0120. How much is that pay for that?
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] OK, that it, the only thing that the only benefits that he had remaining was the $38 so nothing else was paid for that data service because that's, that was the rest of his benefits.
[CUSTOMER][NEUTRAL] Oh, OK, OK.
[CUSTOMER][NEUTRAL] Yes. Is there any way that you can check for me whether the check has been cashed or not?
[AGENT][NEUTRAL] Uh no, it doesn't look like the check is in cash. So, uh, if that is the correct address, then what we can do is we can reissue it.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] E
[CUSTOMER][NEUTRAL] Yes, I think so. Because according to our record, uh, the claim is still open. I mean, we haven't received any payment for this claim yet. And the address, let me mention to you again, is [PII].
[AGENT][NEUTRAL] OK. Well, what I will do is I will go ahead and and um uh
[AGENT][NEUTRAL] Make a note of this where you can have the um uh check reissued if that's the correct address. So I'll go ahead and and put in a request, a request for the check to be issued.
[CUSTOMER][POSITIVE] Oh, OK, great.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, do, do you have, yes, do you have suit C in our address after [PII], it should be [PII]
[AGENT][POSITIVE] OK, sweet, yes, I, we can do that.
[CUSTOMER][NEUTRAL] Oh, OK, yes, because, uh, there are a couple of the businesses in, in the same building, and I don't want it to get lost to somewhere else.
[AGENT][NEUTRAL] Yeah, it looked like it went to Sweet C, so I don't, I don't know why you didn't receive it, but we will go ahead and, and, um,
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, I didn't
[AGENT][NEUTRAL] Uh, send it back. We will go, go ahead and, uh, do that.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Let me see.
[CUSTOMER][NEGATIVE] Yeah, definitely we didn't receive it, yeah, um.
[CUSTOMER][NEUTRAL] [PII], do you know how long it will take for, I mean, for a new check to be issued?
[AGENT][NEUTRAL] Yes, it's usually 3 to 6 business days.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] 03 to 60, that's not so long. OK, so I will keep an eye on that.
[CUSTOMER][NEUTRAL] And um oh I forgot last question about this patient so uh regarding treatment history, do you see anything on file after that date of service after [PII]? Did the patient have any history?
[AGENT][NEGATIVE] Uh, no.
[AGENT][NEUTRAL] No, I don't have anything else for him.
[CUSTOMER][NEUTRAL] Oh, OK, OK, great, yes, um.
[CUSTOMER][NEUTRAL] OK, great. So it's unclear about this patient. I have no further question to ask. Thank you so much, [PII], for your help. And uh last of all, may I please get a reference number for our call today?
[AGENT][NEUTRAL] Yes, my name is [PII]. The first letter of my last name is [PII]. We're gonna use that today's date as our reference. And uh so we will go ahead and get that taken care of for you.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Yes, OK, great. Thank you so much, [PII], for your help. That's been really appreciated and uh it's all for today. Uh, take care. Have a very good day and enjoy your weekend too. Yeah. Thank you. OK.
[AGENT][POSITIVE] OK. Thank you for.
[AGENT][POSITIVE] You too. Thank you for contacting A you have a good day