AccountId: 011433970860
ContactId: ab86649b-19b5-488f-abdc-bb6d291606c8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 352690 ms
Total Talk Time (AGENT): 107188 ms
Total Talk Time (CUSTOMER): 84856 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/13/ab86649b-19b5-488f-abdc-bb6d291606c8_20250313T20:50_UTC.wav
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[AGENT][NEUTRAL] And thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, this is [PII] here calling from Market and the provider's office. I need to verify the patient's eligibility and benefit details. Could you assist me regarding this?
[AGENT][NEUTRAL] Sure, [PII], I can assist you with that information. Um first, could I get a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Uh, the callback number is [PII] and the ending extension is [PII].
[AGENT][NEUTRAL] OK. And please repeat your name.
[CUSTOMER][NEUTRAL] I can see uh the patient's first name is [PII], [PII] is the first name and the last name is [PII] [PII]
[AGENT][NEUTRAL] OK, and the policy number, please?
[CUSTOMER][NEUTRAL] Uh, just a minute. I can see that the patient's policy number starts with uh 614887.
[AGENT][NEUTRAL] And please verify [PII]'s date of birth.
[CUSTOMER][NEUTRAL] That's [PII].
[AGENT][NEUTRAL] And what's the date of service and bill charges on the claim you're calling about?
[CUSTOMER][NEUTRAL] Uh, I need, I'm not falling for the claim services, ma'am. I need to verify the patient's eligibility and benefits.
[AGENT][NEUTRAL] OK, just let me advise you that verification of coverage does not guarantee payment of claims. The effective date on this policy was [PII] and the policy is still active.
[CUSTOMER][NEUTRAL] 0728
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Of
[CUSTOMER][NEUTRAL] OK, and could you assist me with the deductibles and annual max participation policy?
[AGENT][NEUTRAL] Yes, one moment, please.
[AGENT][NEUTRAL] say, the annual maximum is 1000 per calendar year.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] With a $50 deductible.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, uh, I need to confirm the conscience percentage for preventative basic and measure.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] OK, for all benefits, including basic and major, we cover up to $1000 per calendar year with a $50 deductible that needs to be met first.
[CUSTOMER][NEUTRAL] This is with the group name or group number? Is there any group name or group number?
[AGENT][NEUTRAL] Yes, the group name is.
[AGENT][NEUTRAL] The group, well, let's see.
[AGENT][NEUTRAL] Actually, there isn't a group name or a group number under this policy.
[CUSTOMER][NEUTRAL] Uh, can you assist me then, uh, and the effective date is [PII], right?
[AGENT][NEUTRAL] The effective date is [PII].
[CUSTOMER][NEUTRAL] OK, I need to confirm as a patient as a policy holder for this plan, right?
[AGENT][NEUTRAL] Yes, he is.
[CUSTOMER][NEUTRAL] OK, is there any waiting period applies for this patient's policy?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Um, no, I'm not showing any waiting periods.
[CUSTOMER][NEUTRAL] OK, uh, I need to confirm the, uh, is there any used amount from the annual max $1000?
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] No, he hasn't used any of his benefits this year.
[CUSTOMER][NEUTRAL] Um, when are the last to maximum for the orthodontics.
[AGENT][NEUTRAL] No, he hasn't used any of his benefits and
[AGENT][NEUTRAL] Orthodontics.
[AGENT][NEUTRAL] It applies to the $1000 calendar year maximum.
[CUSTOMER][NEUTRAL] Oh yeah.
[AGENT][NEUTRAL] And he hasn't used any this year.
[CUSTOMER][NEUTRAL] Uh, is there any
[CUSTOMER][NEUTRAL] Uh, is there any history for this patient's policy which books a frequency or is there any history for this year?
[AGENT][NEUTRAL] Let's see one moment.
[AGENT][NEUTRAL] Um, no, I'm not showing any.
[CUSTOMER][NEUTRAL] Could you assist with your name and call reference number please?
[AGENT][NEUTRAL] The call reference number is my name and today's date. My name is [PII]. It's spelled [PII] is [PII] and today's date. Is there anything else that I can assist you with?
[CUSTOMER][POSITIVE] Nothing, thank you for providing valuable information. Have a nice day.
[AGENT][NEUTRAL] You do the same, [PII]. Thank you for calling APL. Mm bye.
[CUSTOMER][NEUTRAL] Bye.