AccountId: 011433970860
ContactId: adc1e6ea-ffd4-4bcc-b61b-963cdd647f10
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 532140 ms
Total Talk Time (AGENT): 183887 ms
Total Talk Time (CUSTOMER): 90642 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/12/adc1e6ea-ffd4-4bcc-b61b-963cdd647f10_20250212T18:54_UTC.wav
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[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Uh, yes, ma'am, I have a few questions on my patient's policy.
[AGENT][NEUTRAL] OK, I can help you with questions on the policy. Can I please get your name and your callback number?
[CUSTOMER][NEUTRAL] [PII] and the number is [PII].
[AGENT][NEUTRAL] OK, thank you, [PII]. What is the patient's name?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, what's [PII]'s date of birth?
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] And her policy number?
[CUSTOMER][NEUTRAL] It is 1266.
[CUSTOMER][NEUTRAL] 451.
[AGENT][NEUTRAL] OK, let me look that up.
[AGENT][NEUTRAL] OK, I've got [PII] pulled up. She does have an active policy.
[AGENT][NEUTRAL] And her effective date is
[AGENT][NEUTRAL] [PII], and if you give me your fax number, I can send you a fax back with the complete benefit breakdown for her.
[CUSTOMER][NEUTRAL] Yes ma'am, it's [PII].
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I get that faxed together for you and I'll be right back.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] come back.
[AGENT][POSITIVE] Good.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Hi [PII], this is [PII] back with you again. I have that fax on its way to you right now.
[CUSTOMER][NEUTRAL] OK, I do have a question. Is the patient gonna be eligible tomorrow on [PII] for a cleaning exam and X-rays?
[AGENT][NEUTRAL] OK, let me see if she has any claims.
[AGENT][NEUTRAL] OK, can you give me the procedure codes and I can tell you when the last time the procedure was done?
[CUSTOMER][NEUTRAL] Yes ma'am, um, D0120.
[CUSTOMER][NEUTRAL] D1110.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] D
[CUSTOMER][NEUTRAL] 0274.
[CUSTOMER][NEUTRAL] And D 1206.
[AGENT][NEUTRAL] OK, let me look those up real quick.
[AGENT][NEUTRAL] OK, I don't see any claims for D0120 that have been ever submitted.
[CUSTOMER][NEUTRAL] She's never had a periodic oral evaluation, the D0120.
[AGENT][NEUTRAL] No, I'm
[AGENT][NEUTRAL] I'm searching by uh.
[AGENT][NEUTRAL] Procedure D0120 is not showing that she's had that done.
[CUSTOMER][NEUTRAL] Oh, it's D0120.
[AGENT][NEUTRAL] And then the.
[AGENT][NEUTRAL] Yes, D 0120.
[AGENT][NEUTRAL] Yeah, that's not pulling anything up for me and then let me look at D1110.
[AGENT][NEGATIVE] That's not pulling up for me.
[AGENT][NEUTRAL] So it's not been done D 0274.
[AGENT][NEUTRAL] OK, I see what it's doing. Let me, let me look again.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] We have a way we can't put the D in so let me go back to the original first diagnosis code or the procedure code. I'm sorry.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] So she had um.
[AGENT][NEUTRAL] The D
[AGENT][NEUTRAL] 0120 done on [PII].
[AGENT][NEUTRAL] What's the last one now let me check the other code.
[AGENT][NEUTRAL] 01110 was done on.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] 274.
[AGENT][NEUTRAL] Was done [PII].
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] The 01206 was done on [PII].
[CUSTOMER][NEUTRAL] So the patient is eligible for all those?
[AGENT][NEUTRAL] So on her fax back, it'll say that the cleanings are once every 6 months, exams are 2 every 12 month period.
[AGENT][NEUTRAL] 2 per 12-month period, bite wings are once every 12-month period. Full mouth x-rays and pangramics are done every 5 years.
[CUSTOMER][NEUTRAL] OK and then um.
[CUSTOMER][NEUTRAL] Let me see, is it 6 months to the day?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, so 6 months to the day and then 12 months to the day on the [PII]?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] To the day.
[CUSTOMER][NEUTRAL] OK and then can I get a reference number?
[AGENT][NEUTRAL] Yes, you can use my name. It's [PII] and today's date. And can I get the name of the um facility you're calling from, [PII]?
[CUSTOMER][NEUTRAL] Kingwood Dental.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][POSITIVE] Yes ma'am thank you so much.
[AGENT][POSITIVE] You're very welcome you have a good day and thanks for calling APL.
[CUSTOMER][NEUTRAL] You too bye bye.