AccountId: 011433970860
ContactId: bbd988db-ac1a-4375-8ded-3200f8a78343
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 746640 ms
Total Talk Time (AGENT): 346500 ms
Total Talk Time (CUSTOMER): 312872 ms
Interruptions: 4
Overall Sentiment: AGENT=1.2, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/30/bbd988db-ac1a-4375-8ded-3200f8a78343_20250130T22:08_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Oh, I
[CUSTOMER][NEUTRAL] Yes, um, I am trying to verify a dental benefit for a patient, please.
[AGENT][NEUTRAL] Yeah.
[AGENT][POSITIVE] Well, it would be my pleasure to assist you with that benefit. What is your name, please?
[CUSTOMER][NEUTRAL] We
[CUSTOMER][NEUTRAL] Yep, it is [PII] excuse me, [PII]
[AGENT][POSITIVE] Thank you, [PII], and a good callback number please, ma'am.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you, [PII], and the policy number for the patient, please?
[CUSTOMER][NEUTRAL] OK, I have 02408581.
[AGENT][NEUTRAL] Thank you and the patient's name and date of birth, please, ma'am.
[CUSTOMER][NEUTRAL] Yep, it's [PII] and it's [PII].
[AGENT][NEUTRAL] Bear with me just one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm looking for that name, so bear with me.
[CUSTOMER][POSITIVE] Yeah, no problem, and I know you gave me your name, but what was your name again? I'm so sorry.
[AGENT][NEUTRAL] The
[AGENT][NEUTRAL] Not a problem. My name is [PII]
[AGENT][NEUTRAL] First initial last name [PII].
[CUSTOMER][NEUTRAL] Can
[AGENT][NEUTRAL] And [PII] is, does she go by another name?
[CUSTOMER][NEUTRAL] No, not that I'm aware of. Oh hey, is it, well, she, they do have wrote down um [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I think I see that now. Her, that is her legal name what I gave you though.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said her date of birth is?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] It's so close to what I have, but it's not what I have.
[CUSTOMER][NEUTRAL] Uh, you're kidding me. Let me look here, make sure, let me, I think we have our license, maybe let me see.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Oh, do you know that's it.
[CUSTOMER][NEUTRAL] Could it be, do you have [PII] or [PII]?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Oh, you're kidding [PII]. I'm looking at her.
[CUSTOMER][NEUTRAL] [PII], I don't know what that is, to be honest, what I'm looking at, but it's what she gave her identification. Alrighty, but [PII].
[AGENT][NEUTRAL] Let me ask you something. Do you have the policyholder's name and date of birth? I can give you eligibility.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] I mean I don't know if I have that even but it could be [PII].
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And his date of birth is [PII].
[AGENT][POSITIVE] Hot dog we got something.
[CUSTOMER][POSITIVE] OK, thank goodness.
[AGENT][NEUTRAL] I can tell you the policy is active.
[AGENT][NEUTRAL] With the effective date of [PII].
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The dependent is
[AGENT][NEUTRAL] Covered Carolina.
[CUSTOMER][NEUTRAL] Uh-huh, Carolina.
[AGENT][NEUTRAL] Let me check this, hang on just a second.
[AGENT][NEUTRAL] And the policy is active.
[AGENT][NEUTRAL] Let me check.
[CUSTOMER][NEUTRAL] Well, is it? Let me see, OK, you go on, yes.
[AGENT][NEUTRAL] Yeah, the policy is active.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK doke.
[AGENT][NEUTRAL] I'm checking something else.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Do you mind holding on just a second, let me check with customer service and.
[CUSTOMER][NEUTRAL] Nope
[AGENT][NEUTRAL] See if they can verify the.
[CUSTOMER][NEUTRAL] Excuse me, no, I don't mind at all.
[AGENT][NEUTRAL] Date of birth.
[AGENT][POSITIVE] OK, thank you. Bear with me just one second. I appreciate it, [PII]. One moment.
[CUSTOMER][NEUTRAL] You bet.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Referring.
[CUSTOMER][NEUTRAL] Thank you for calling APL. This is [PII] in customer service. How may I help you?
[AGENT][NEUTRAL] Well, hey, [PII], it's been a while since I've talked to you. How are you doing?
[CUSTOMER][POSITIVE] Hi [PII], I'm good. How are you?
[AGENT][NEUTRAL] I'm good, thank you. I have got a provider on the line to check eligibility. I have a different date of birth, sorry, not service, and I don't see an application. Can you just check, I see that we've got had claims on this dependent. Nobody's questioned the date of birth.
[CUSTOMER][NEUTRAL] Mm, OK, what's the policy number we're looking at?
[AGENT][NEUTRAL] 240-8581
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] The policy is under [PII], but we're looking at Carolina.
[CUSTOMER][NEUTRAL] 240
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh boo, it's universal trucking. OK. Usually there's not an application for them. Did you check?
[AGENT][NEUTRAL] How do we, yeah, I didn't see anything in on bases.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So, basically, the only thing we can do is check with um
[CUSTOMER][NEUTRAL] The group to verify the date of birth because the, the group is the source of truth.
[CUSTOMER][NEUTRAL] Um, when it comes to, you know, data like that, and so whatever they have is what we're supposed to go by.
[AGENT][NEUTRAL] How would we enter in.
[AGENT][NEUTRAL] Yeah, how would we enter in the date of birth?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] What do you mean like in the initial.
[AGENT][NEUTRAL] Yeah, when we're
[AGENT][NEUTRAL] Because all of her claims say 106.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But we have 108 and she's got the provider has like a license but it's not like a [PII] license that has 106 on it but.
[CUSTOMER][NEUTRAL] This is
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I reckon I can verify the benefits for [PII].
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] So she gave me his information.
[CUSTOMER][NEUTRAL] Yeah, um.
[CUSTOMER][NEUTRAL] Yeah, now as far as verifying the benefits, I mean.
[CUSTOMER][NEUTRAL] I don't know. I mean, we would have to get, we would need to send a, I guess you would need to send a hub request for CS to reach out to the group to verify that date of birth, yeah, um, so I'm not sure about the.
[AGENT][NEUTRAL] For the date of birth. OK. OK, cool.
[AGENT][NEUTRAL] Oh yeah.
[CUSTOMER][NEUTRAL] Uh, verifying the benefits though, but if we paid out a claim on her before.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I can I can I can handle the benefits. I just, I just hate to, I mean, we got to check this stuff people. I'm sorry.
[CUSTOMER][NEUTRAL] OK. Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] No, it's alright, uh, but yeah, send the, send a hub request, uh.
[AGENT][NEUTRAL] I'm doing it.
[CUSTOMER][NEUTRAL] To verify the date of birth so that we can get that fixed and um yeah.
[AGENT][POSITIVE] Perfect.
[AGENT][POSITIVE] All right. I really do appreciate your help, memory. I am going to send a little, I'm gonna hub it.
[CUSTOMER][NEUTRAL] Because
[CUSTOMER][POSITIVE] No problem, lady.
[AGENT][POSITIVE] And I'm gonna get this provider taken care of. Thank you.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] You're welcome. Have a good day.
[AGENT][POSITIVE] Uh, yeah. You too. Thank you, [PII]. Bye-bye.
[CUSTOMER][POSITIVE] You're welcome. Bye.
[AGENT][POSITIVE] OK, Ms. [PII], thank you for your patience. I appreciate that. Um,
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] We're going to research that date of birth, but I'm gonna, I'm gonna help you since you verified [PII]'s information, cause it's the same information on the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Oh, thank you.
[CUSTOMER][POSITIVE] OK, got it perfect.
[AGENT][NEUTRAL] So her policy is active as of [PII].
[CUSTOMER][NEUTRAL] Um, I, yeah.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This is a UCR policy, no network participation.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Are you needing a breakdown?
[CUSTOMER][NEUTRAL] Well, not necessarily, um, she is coming in.
[CUSTOMER][NEUTRAL] And uh she's having just two codes is all I think I need. It's a 7210 and a 6010.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 7210 and 6010.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Let me get that.
[AGENT][NEUTRAL] Now I got to, got to go to another place, so bear with me. I apologize. I'm just a stickler on that kind of stuff.
[CUSTOMER][POSITIVE] You're good.
[CUSTOMER][POSITIVE] Yeah, you go for it.
[AGENT][NEUTRAL] You know, we've got to uh.
[CUSTOMER][POSITIVE] I, I like accurate.
[AGENT][NEUTRAL] Yeah, so you might wanna just tell her that we, you know, she comes in, that they may wanna call in, we can correct the date of birth if it's by the uh insured.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] You bet.
[AGENT][NEUTRAL] And we'll get that taken care of. So for those two codes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] I got that policy pulled up and I'm checking on this for you right now.
[AGENT][NEUTRAL] Scroll down to the 7210 and the 6010.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 6 to 10 I'm checking I don't see that listed, but I'm gonna check further on that one.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] The 7210 is covered under oral surgery at 40%, and they have satisfied their twelve-month waiting period for major procedures.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEGATIVE] Now the, the 6010, I just don't, that's just not a listed benefit on her policy.
[CUSTOMER][NEUTRAL] I bet it's an implant, so I was just wondering.
[AGENT][NEUTRAL] Oh, yeah, we don't cover implants. I'm sorry, I should have.
[CUSTOMER][NEUTRAL] OK. Oh no, I should have told you that then.
[AGENT][NEUTRAL] Girl.
[AGENT][NEUTRAL] I don't know these codes. Yeah, implants are not covered, nor any services associated with the implants, but the 7210 is covered at 40% of usual customary rates.
[CUSTOMER][NEUTRAL] I'm telling you.
[CUSTOMER][NEUTRAL] Bye.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] Well, that is perfect then and what about the deductible and max? I was gonna ask you.
[AGENT][NEUTRAL] And that's
[AGENT][NEUTRAL] So she has not met her deductible for [PII].
[AGENT][NEUTRAL] And the calendar year max is $1500. Now that is a verification of coverage, not a guarantee of payment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And we've got all that. Is it, yeah, waiting periods up. I have that I have her card. uh, what is, can you just confirm the claims address?
[AGENT][NEUTRAL] Sure, that is [PII].
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] 950.
[CUSTOMER][NEUTRAL] 50 people.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And the zip code is
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And the
[CUSTOMER][NEUTRAL] 10 or 1000.
[AGENT][NEUTRAL] You can also fax claims to our claims department.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] And um we have a payer ID as well, but our fax number is 877.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] 365.
[AGENT][NEUTRAL] 942 3.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] All right well thank you so much.
[AGENT][POSITIVE] It's been such a pleasure to assist you. Thank you for your patience as we reviewed that date of birth, and we'll get that.
[CUSTOMER][POSITIVE] Absolutely.
[AGENT][POSITIVE] We're gonna research that on our end and get that corrected if, if it can be corrected, but it has been such a pleasure to assist you and I hope you have a lovely evening.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Hey, you do the same, [PII] thank you so much.
[AGENT][POSITIVE] Thank you for calling APL. Take care and have a lovely evening. Bye-bye.
[CUSTOMER][POSITIVE] You too. You too. Bye-bye.