AccountId: 011433970860
ContactId: a9220a0f-319c-4cf0-99a9-49860f58e3f7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 206759 ms
Total Talk Time (AGENT): 138744 ms
Total Talk Time (CUSTOMER): 53797 ms
Interruptions: 1
Overall Sentiment: AGENT=1, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/a9220a0f-319c-4cf0-99a9-49860f58e3f7_20250121T17:00_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thank you for contacting APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII] and I'm calling from Doctor [PII]'s office.
[CUSTOMER][NEUTRAL] And I'm calling to check on benefits for one of our patients for dental.
[AGENT][NEUTRAL] I can help with benefits [PII]. What is that policy number, please?
[CUSTOMER][NEUTRAL] OK, give me one second, dear, it's so small, uh, let's see.
[CUSTOMER][NEUTRAL] It is D41203440.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, how do you spell the patient's last name, please?
[CUSTOMER][NEUTRAL] It's [PII]
[AGENT][POSITIVE] Thank you. And the first name?
[CUSTOMER][NEUTRAL] Is [PII]
[AGENT][NEUTRAL] And OK. And her date of birth, please?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, let me see if I can find it that way, and I just need a callback number please in the event that we're disconnected.
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] Thank you. Her policy number is 02543088. That went into effect on [PII], and it is active. Now, these policies have $500 per calendar year as the maximum.
[AGENT][NEUTRAL] That's just a verification of the benefits, not a guarantee of payment. I can send you a fax if you would be interested. What uh the policy does is that this is a very limited benefit policy. It covers um basic.
[AGENT][NEUTRAL] Basic restorative and preventative services only, um, and I don't show that she's ever used it, so that, uh, that $500 which again is just a verification, not a guarantee of payment, and that doesn't look like any of that has been used, so it looks like she would, uh, she still has all of that available.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And would that tax have a full breakdown of all the benefits?
[CUSTOMER][NEUTRAL] That she does have?
[AGENT][NEUTRAL] Yes, it, yes, it tells you exactly what is covered, uh, what is not covered. Um, basically, major medical endedontics periodontal services, oral surgery, that is not uh covered by her policy. Um, it's all just very, very basic dentistry, but, uh, and there is no network, um, because it is just such a basic service. Now, what is your, uh, fax number so
[CUSTOMER][NEUTRAL] I'm sorry, did you say it's in network you said?
[AGENT][NEUTRAL] Uh, there is no network, um, because it is a, a very basic, yeah. What is your fax number so I can send this to you?
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. I'm gonna go ahead and send this to you now and if you do have any questions, um please just let us know, but that is what the, the policy does, that is what it pays and um uh.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and will that fax have the um mailing address for claims as well?
[AGENT][NEUTRAL] Yes, we have a mailing address. We also have a payer ID for electronic submissions. It's 60801. You're going to see that all on there. We also have a um mailing, excuse me, a online service center if you wish to send it that way. So there's gonna be several different ways of getting that to us. Now, is there anything else before I send off this fax? Is there anything else at all that I can help with?
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That is it, thank you so much.
[AGENT][POSITIVE] OK, thanks for contacting AT have a good.