AccountId: 011433970860
ContactId: bc2fbfd3-ec6e-4d04-b5ac-553cb0c5fe0f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 503940 ms
Total Talk Time (AGENT): 163233 ms
Total Talk Time (CUSTOMER): 155712 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/bc2fbfd3-ec6e-4d04-b5ac-553cb0c5fe0f_20250304T17:07_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Uh, yes, I need to see if a patient, um, has active coverage and then get a few, uh, benefits breakdown please.
[AGENT][NEUTRAL] May I please have your name and a callback number?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] And [PII], we do have a fax back for for a policy. Would you like for me to fax that information over to you as well?
[CUSTOMER][POSITIVE] Yeah, that'll work.
[AGENT][NEUTRAL] OK, and may I have a fax number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And may I have that policy number?
[CUSTOMER][NEUTRAL] Um, it's 02582695.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And I also need to see if we are in network with this one as well.
[AGENT][NEUTRAL] OK, so with our policies, it doesn't, it's not an in or out of network policy.
[CUSTOMER][NEUTRAL] Please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And may I have the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Well, I only have her insurance card Ever [PII].
[CUSTOMER][NEUTRAL] I don't think I have her date of birth.
[CUSTOMER][NEUTRAL] Give me 1 2nd, I can ask her.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, one second
[CUSTOMER][NEUTRAL] I'm so sorry, it's uh [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] And thank you so much [PII] for verifying this member's policy. You're calling in for eligibility and for a fax back. I will get that fax back submitted over to you and for this member, it does show that it's currently active. The effective date is [PII].
[CUSTOMER][NEUTRAL] Alrighty, um, as far as just real quick because she is here, um, as far as, uh, preventative and diagnostic, does that pay out 100%?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Let me pull that up for you.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And in regards to the member's benefit, verification of coverage does not guarantee the payment of the claim. For preventative, the member does have up to 100%.
[AGENT][NEUTRAL] Coverage. Now for the diagnostic, is there a specific procedure code that you would like for me to review?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Well,
[CUSTOMER][NEUTRAL] Uh, what it
[CUSTOMER][NEUTRAL] I guess rather do X-rays if I take a pin, a panel, a bite ling and PAs on the same day, are those gonna downgrade to a full now?
[CUSTOMER][NEUTRAL] And I have codes if you want those.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] OK, so I see we do have different codes for the bite wings.
[CUSTOMER][NEUTRAL] Uh, the one that we would use is 0274.
[AGENT][NEUTRAL] And that is listed up on the preventative, so that would be at 100%.
[AGENT][NEUTRAL] And what is the code for the panel?
[CUSTOMER][NEUTRAL] 0330.
[AGENT][NEUTRAL] So for the panel that member it will cover up to 80%.
[AGENT][NEUTRAL] For the panel.
[CUSTOMER][NEUTRAL] Got you. OK, let me see.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] The bite wings are covered at 100%?
[AGENT][NEUTRAL] The bite wings for the COVID, for the cold, it is covered at 100%.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] What about um the code 0220 are those 80% or 100%?
[CUSTOMER][NEUTRAL] Hello
[AGENT][NEUTRAL] That's the first film. Let me pull that up for you.
[AGENT][NEUTRAL] That is showing at 80% as well.
[CUSTOMER][NEUTRAL] Yes, please.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] OK dokey um.
[CUSTOMER][NEUTRAL] Can we take a pan, is that once every 5 years?
[AGENT][NEUTRAL] For the panel, is showing it's limited to 1 X-ray procedure for 5 years.
[CUSTOMER][NEUTRAL] 5 years.
[CUSTOMER][NEUTRAL] OK dokey let me see.
[CUSTOMER][NEUTRAL] And we can take a pan and bite wing on the same day.
[CUSTOMER][NEUTRAL] And that.
[AGENT][NEUTRAL] It's not showing any frequencies, but let me make sure.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm not seeing any frequencies on that for the bite wings and the banner.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Awesome, um, what about fluoride?
[AGENT][NEUTRAL] May I have that code please?
[CUSTOMER][NEUTRAL] Uh yes, I'm sorry, it's 1206.
[AGENT][NEUTRAL] And this is for an adult?
[CUSTOMER][NEUTRAL] Um, just I guess if there is an age limit.
[CUSTOMER][NEUTRAL] And and the frequency.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] That you're
[AGENT][NEUTRAL] OK, so for the.
[AGENT][NEUTRAL] Fluoride, it only covers up to age [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And then
[AGENT][NEUTRAL] Let me see
[AGENT][NEUTRAL] So if it's for the age of [PII], then we don't cover it for this member.
[CUSTOMER][NEUTRAL] Got you. Um, real quick, uh, does the preventative and diagnostic go to the towards the deductible?
[AGENT][NEGATIVE] The preventative does not apply to the deductible.
[CUSTOMER][NEUTRAL] One that you'll
[CUSTOMER][NEUTRAL] Does the diagnostic.
[CUSTOMER][NEUTRAL] Plant
[AGENT][NEUTRAL] The diagnostic is not listed as preventative, so it will go towards the deductible.
[CUSTOMER][NEUTRAL] Got you. And was that a $50 deductible?
[AGENT][NEUTRAL] So for the calendar year, verification of coverage does not guarantee the payment of the claim. The member does have up to $50 per covered insured.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] For the deductible and then for the calendar year max, they have up to $500.
[CUSTOMER][NEUTRAL] Oh, just a $500 max.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK awesome that's all I needed thank you so much I appreciate it.
[AGENT][NEUTRAL] OK, now did you still need me for the to submit the fax back as well?
[CUSTOMER][POSITIVE] Uh yes please, yes.
[AGENT][POSITIVE] OK, I will get that over to you. Thank you so much for calling American Public Life. Have a great rest of your day.
[CUSTOMER][POSITIVE] Thank you you too.
[AGENT][POSITIVE] Thank you. Bye.