AccountId: 011433970860
ContactId: adb157f3-ea68-42a9-b7d0-1869776c4c11
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 399890 ms
Total Talk Time (AGENT): 171987 ms
Total Talk Time (CUSTOMER): 124398 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/adb157f3-ea68-42a9-b7d0-1869776c4c11_20250225T18:49_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thank you for calling American Public Life. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I was calling to verify benefits for a patient.
[AGENT][NEUTRAL] OK, I can help you with that. Could I get a callback number?
[CUSTOMER][NEUTRAL] Yes, our number here is gonna be [PII].
[AGENT][POSITIVE] Thank you and what is your name?
[CUSTOMER][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] OK, thank you, [PII], and what is the policy number you're calling on?
[CUSTOMER][NEUTRAL] Uh yes, it is gonna be 02576213.
[AGENT][NEUTRAL] The patient's name and date of birth.
[CUSTOMER][NEUTRAL] Uh, name is [PII]. Date of birth is [PII].
[AGENT][POSITIVE] OK, thank you so much for verifying.
[AGENT][NEUTRAL] Uh, the policy and you did say you are calling for benefits. Uh, now would you like us to send over a fax back?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Uh, with the benefits and procedure cover procedures.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh, yes, or you can go around whichever way works for you.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Let me get it pulled up.
[CUSTOMER][POSITIVE] Great
[CUSTOMER][NEUTRAL] How are you?
[CUSTOMER][NEUTRAL] is.
[AGENT][NEUTRAL] And if you could verify the, um, patient's name and date of birth one more time. I'm sorry.
[CUSTOMER][NEUTRAL] Um, [PII] and his date of birth is [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Per
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Today, OK, I do show that his policy is active with us. He has been effective since uh [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And, uh, [PII], would I be sending this fax to you, to your attention?
[CUSTOMER][NEUTRAL] Uh, yes, that's fine.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and what is that fax number?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK. I have [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, it is on its way. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, yes, because he's actually having oral surgery, um, and so these codes actually might not even be on there. Um, if you give me just one second, I can check on the list real quick so I can just see which ones I'm gonna need.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um.
[CUSTOMER][NEUTRAL] Alright, give me just one second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then he's getting.
[CUSTOMER][NEUTRAL] Anesthesia.
[CUSTOMER][NEUTRAL] OK, um, you want me to give you all the codes it's like.
[AGENT][NEUTRAL] I just start, we can go one by one. What is the first one?
[CUSTOMER][POSITIVE] OK, perfect. First one is 7140.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK. 7140 is not a covered procedure.
[CUSTOMER][NEUTRAL] OK, 7210.
[AGENT][NEUTRAL] 70 to 10. 0 wait, I'm sorry, 7140 is covered.
[AGENT][NEUTRAL] Uh, let's see, extraction of erupted tooth. Let me see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that is covered up to 12.
[AGENT][NEUTRAL] And then you said 7120?
[CUSTOMER][NEUTRAL] 70, 7 to 10. So what percent is the 7140 covered at?
[AGENT][NEUTRAL] So that is covered under their basic benefit. Please be advised verifying benefits does not guarantee payment. Uh, it looks like basic expenses are covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Up to 80% of the uh usual and customary amount um and they, he does have a $50 deductible calendar year deductible that has to be met prior to that, um, and the next code you said was 70.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 7210.
[AGENT][NEUTRAL] 7210. OK, 72.
[AGENT][NEUTRAL] OK, 7210 is not a covered benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then 7250.
[AGENT][NEUTRAL] 7250 is not a covered benefit.
[CUSTOMER][NEUTRAL] OK, and then 7230?
[AGENT][NEUTRAL] 7230 is not a covered benefit.
[CUSTOMER][NEUTRAL] 7240.
[AGENT][NEGATIVE] 7240 is not covered.
[CUSTOMER][NEUTRAL] OK, and then 9222?
[AGENT][NEUTRAL] 9222 is not a cover procedure.
[CUSTOMER][NEUTRAL] OK, I mean this one probably not either 9223.
[AGENT][NEUTRAL] 9223 is not covered.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else I can help you with?
[CUSTOMER][NEUTRAL] All right, um,
[CUSTOMER][NEUTRAL] Nope, that is it. And then you said that faxed it you already sent that fax, right?
[AGENT][NEUTRAL] Yes, it is going through at this time.
[CUSTOMER][POSITIVE] OK perfect thank you. Oh, can I get a call reference? I'm sorry.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] Yes, to reference our call, you'll use my name, [PII] and today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] All right perfect thank you.
[AGENT][POSITIVE] You're welcome you have a wonderful day and thank you for calling APL.
[CUSTOMER][NEUTRAL] Uh bye bye.
[AGENT][NEUTRAL] Bye bye.