AccountId: 011433970860
ContactId: aed687d2-3b0b-4050-81a5-3c5f07aa2e0f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 345660 ms
Total Talk Time (AGENT): 190609 ms
Total Talk Time (CUSTOMER): 157621 ms
Interruptions: 4
Overall Sentiment: AGENT=0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/15/aed687d2-3b0b-4050-81a5-3c5f07aa2e0f_20250515T14:13_UTC.wav
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[CUSTOMER][NEUTRAL] Oh, look, it could be [PII].
[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from a dental specialist regarding one of your members, please.
[AGENT][NEUTRAL] OK, were we needing to check our eligibility?
[CUSTOMER][NEUTRAL] Yes, I need to check eligibility and see if we're in network, please.
[AGENT][NEUTRAL] OK, I can check that for you. uh, [PII], can I get a good call back number from you first in case we're disconnected?
[CUSTOMER][POSITIVE] Doing cool.
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you. Do you have the member's policy number?
[CUSTOMER][NEUTRAL] Uh, on this card there is a policy slash cert number. Sure, 020.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 02016482
[AGENT][NEUTRAL] OK and then what was the name and date of birth for the member please?
[CUSTOMER][NEUTRAL] His name is [PII].
[CUSTOMER][NEUTRAL] And his date of birth is.
[CUSTOMER][NEUTRAL] Hold on for me please. Date of birth is [PII].
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Perfect, thank you for verifying that. uh, so this policy is active. Effective date was [PII], and this policy is, uh, doesn't have a network. It, uh, pays a percentage based off of UCR, and if you'd like I can send you a fax back that shows all of the coverage procedures and benefit information.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so it pays something if I gave you some code, would you let me know what you pay, please?
[AGENT][NEUTRAL] Oh sure, um, it wouldn't be uh it would be a percentage again based off of UCR, um, but I can definitely check to see if those codes are covered.
[CUSTOMER][NEUTRAL] Our percentage.
[CUSTOMER][NEUTRAL] OK, hold on one second please.
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Hi, I'm sorry, what, what did you pay? But not network, she said, so what did you pay? What's the number? The tooth is 3320.
[AGENT][NEUTRAL] Hello.
[AGENT][NEGATIVE] No, it's, no, no.
[AGENT][NEUTRAL] Hold on, um, I just, I just wanna verify that um so if this plan is not affiliated with a network it pays a percentage based off of UCR so it could be used anywhere.
[CUSTOMER][NEUTRAL] Yes, go ahead.
[CUSTOMER][NEUTRAL] Oh, OK, so say, OK, there's a work now that needs to be done on patient.
[AGENT][NEUTRAL] It depends on the code so in short, um, this.
[CUSTOMER][NEUTRAL] Do you pay an assignment or no, like to the patient to the doctor's office or no?
[AGENT][NEUTRAL] Whoever files the claim, so if the provider is the one to file the claim, we would send that uh payment to you.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] If the member filed the claim we would send it to the member.
[CUSTOMER][NEUTRAL] OK, now if I give you fees and codes you'll be able to tell me or no?
[AGENT][NEUTRAL] Yes, um, I can, uh, if you look up, excuse me, if you can give me those codes, I'll let you know, um, but I can tell you in short, um, for this plan preventative pays 100% of UCR, uh, FMX radiographs and basic all pay 80%.
[CUSTOMER][NEUTRAL] OK, sure.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] We're a root canal specialist just so you know, so, so I have 3 codes.
[AGENT][NEUTRAL] OK, OK. Sure, OK, that might be easier. OK, go ahead.
[CUSTOMER][NEUTRAL] 0140 after the D D 0220 then D 3320.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, one moment, let me see what those are at.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So 0140 is covered under this policy under basic so that would be 80% of UCR.
[CUSTOMER][NEUTRAL] So I mean say we charge $100 what do you pay?
[AGENT][NEUTRAL] It goes up again, so UCR based off of um the area so assuming that is baseline for UCR we would pay 80% of that.
[CUSTOMER][NEUTRAL] OK, then 0220.
[AGENT][NEUTRAL] 0220 is also covered under basic, so 80% and then the last one you said was 3320?
[CUSTOMER][NEUTRAL] Right.
[AGENT][NEUTRAL] OK, that one is covered under endoontic, uh, so that would be 40% of UCR that we would pay.
[CUSTOMER][NEUTRAL] So you pay 40% only if I give you the fee can't give it to me like um it's definitely 40% if I tell you like 1995 or.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] It's I couldn't give you an exact dollar amount as it's based off of UCR so UCR is going to be the baseline for the specific region, um, not necessarily what y'all charge.
[CUSTOMER][NEUTRAL] Whatever 1000.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] But what was that about no charge? What did you say?
[AGENT][NEUTRAL] Um, so UCR is going to be based off of, uh, I believe it's based off of zip codes, um, when that's gonna be like the baseline for a specific price for procedures. I don't know how to, I don't know how to calculate that that's something that, um, once you file the claims, um, then we would have that information.
[CUSTOMER][NEUTRAL] Well, I have a zip code I can give it to you.
[CUSTOMER][NEUTRAL] You don't know.
[CUSTOMER][NEUTRAL] OK, where does this claim go to, by the way? Is it go to American Public Life insurance?
[AGENT][NEUTRAL] It would go to us. Yes, and I can give you that, uh, we have an, a mailing address, fax number and a payer ID I can give you.
[CUSTOMER][NEUTRAL] What's the mailing address?
[AGENT][NEUTRAL] That is [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And that is in [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, so we'll submit it and then go from there, OK.
[AGENT][NEUTRAL] Alright, was there anything else I can help you with?
[CUSTOMER][NEUTRAL] Um, I think that's it, so you definitely pay the provider, correct?
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] As long as the provider uh the ones that file the claim, yes.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] Yeah, OK, thank you, thank you.
[AGENT][POSITIVE] Of course thank you have a great rest of your day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.