AccountId: 011433970860
ContactId: bc56eb3e-fe7d-490f-aa21-50085d0f300c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 643489 ms
Total Talk Time (AGENT): 175281 ms
Total Talk Time (CUSTOMER): 155659 ms
Interruptions: 0
Overall Sentiment: AGENT=0, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/24/bc56eb3e-fe7d-490f-aa21-50085d0f300c_20250324T19:56_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi [PII], this is [PII] calling from Marke Dental provider's office. I need to verify the patient's eligibility and benefit details. Could you assist me regarding this?
[AGENT][NEUTRAL] Patients eligibility, is that correct?
[CUSTOMER][POSITIVE] That's right.
[AGENT][NEUTRAL] OK [PII], what is your callback number just in case the call gets disconnected?
[CUSTOMER][NEUTRAL] Yeah it's [PII].
[CUSTOMER][NEUTRAL] [PII] and the running extension is [PII].
[AGENT][NEUTRAL] Thank you, sir. And then what's the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] I can see that the patient's policy number is 614228 is the policy number and I can see here the patient's first name is [PII] is the first name and the last name is [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] OK, let me look up his policy real quick.
[AGENT][NEUTRAL] OK, I do show this policy for [PII] is no longer active. The policy's termination date is [PII].
[CUSTOMER][NEUTRAL] OK, uh, could you assist me the effective date for the termination plan?
[AGENT][NEUTRAL] The effective date was [PII] and then the policy terminated on [PII].
[CUSTOMER][NEUTRAL] OK, uh, if you don't mind, I have one more patient. Could you check with those patient details?
[AGENT][NEUTRAL] Alright, let me, uh, look up, let me add my note on this one and then we'll move on to the next one.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] What is the name of the provider's office that you're calling from?
[CUSTOMER][NEUTRAL] It's Mary M A R Q U E E Mary Dental Partners.
[AGENT][NEUTRAL] OK, and what is the next patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Uh, I can see the next patient's first name is uh 614354 is the policy number.
[CUSTOMER][NEUTRAL] And I can see here the patient's first name is [PII] and then A is the first name and the last name is [PII] And the date of birth is [PII].
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Hi, what was the patient's name and date of birth again, please?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And the last name is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, let me pull that policy up real quick.
[AGENT][NEUTRAL] OK, I do show that [PII] does have an active policy, and the effective date is [PII].
[CUSTOMER][NEUTRAL] OK, uh, could you assist me with the deductibles and annual max for this patient's policy?
[AGENT][NEUTRAL] If you give me your fax number, I can send you a fax with the benefit breakdown, deductible, out of pocket, and also the fee schedule.
[CUSTOMER][NEUTRAL] Uh, but I would like to go with the verbal, ma'am. Could you able to provide me this patient's policy information to verbal?
[AGENT][NEUTRAL] OK, let me pull it up real quick.
[AGENT][NEUTRAL] Let me look.
[AGENT][NEUTRAL] OK, and this is just to verify benefits. It's not a guarantee of payment.
[AGENT][NEUTRAL] Patient has a calendar year maximum of $1000 with a calendar year deductible of $50 per covered insured up to $150 for family.
[CUSTOMER][NEUTRAL] OK. Uh, could you assist with the insurance percentage of preventative basic and measure?
[AGENT][NEUTRAL] Basic is.
[AGENT][NEUTRAL] Let me look.
[AGENT][NEUTRAL] OK, this policy does not go by percentage.
[AGENT][NEUTRAL] It goes by a benefit amount.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, is there any group name or group number? It's an individual policy.
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] There is no employer. It is an individual policy.
[CUSTOMER][NEUTRAL] OK, I need to confirm as the patient is a policyholder for this plan, right?
[AGENT][NEUTRAL] Ma'am?
[AGENT][NEUTRAL] say, can you repeat that?
[CUSTOMER][NEUTRAL] Could you be able to confirm it is the patient is a policy holder for this plan?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and is there any used amount from the deductibles and Nano Max?
[AGENT][NEUTRAL] Let me check for you.
[AGENT][NEGATIVE] Nothing has been used.
[AGENT][NEUTRAL] For the year of [PII].
[CUSTOMER][NEUTRAL] OK, uh,
[CUSTOMER][NEUTRAL] Uh, is there any history for this patient's policy which affects the frequency or is a history for this year?
[AGENT][NEUTRAL] Let me check.
[AGENT][NEUTRAL] What um procedures are you looking for?
[CUSTOMER][NEUTRAL] Uh, is there any history for FMX and panel?
[AGENT][NEUTRAL] OK, what is the procedure code?
[CUSTOMER][NEUTRAL] 0210
[AGENT][NEUTRAL] OK, let me look up real quick.
[AGENT][NEUTRAL] The last evaluation was done on [PII].
[CUSTOMER][NEUTRAL] OK, and is there any history for a comprehensive exam D0150?
[AGENT][NEUTRAL] Let me check that one.
[AGENT][NEUTRAL] And you said that was D1050?
[CUSTOMER][NEUTRAL] 0150.
[AGENT][NEUTRAL] No, that's, I don't show any history of that.
[CUSTOMER][NEUTRAL] It's my history for D 0120?
[AGENT][NEUTRAL] Yes, um, the last time that was done was on [PII].
[CUSTOMER][NEUTRAL] Uh D 0140.
[AGENT][NEUTRAL] Can you repeat that number again? 0.
[CUSTOMER][NEUTRAL] D. 0140.
[AGENT][NEUTRAL] No history for that.
[CUSTOMER][NEUTRAL] Uh, is there any history for D1110?
[AGENT][NEUTRAL] The last time that was done was on [PII].
[CUSTOMER][NEUTRAL] OK, D 0274.
[AGENT][NEUTRAL] That was done on [PII].
[CUSTOMER][NEUTRAL] OK, and uh is there any history for 4910?
[AGENT][NEUTRAL] No history for that one.
[CUSTOMER][NEUTRAL] Uh, it's only for 2740.
[AGENT][NEUTRAL] That was done on October.
[AGENT][NEUTRAL] 823.
[CUSTOMER][NEUTRAL] Sorry, could you repeat one second? Your voice is breaking. It's October.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] A tooth number?
[AGENT][NEUTRAL] 25
[CUSTOMER][NEUTRAL] OK, 2 2950.
[AGENT][NEUTRAL] No history for that one.
[CUSTOMER][NEUTRAL] OK, could you assist with your name and call reference number please?
[AGENT][NEUTRAL] Yes, my name is [PII] and you can use my name and today's date.
[CUSTOMER][POSITIVE] Thank you, thank you, [PII], thank you for providing valuable information. Have a nice day.
[AGENT][POSITIVE] You have a good day too, and thank you for calling APL.
[AGENT][NEUTRAL] Mhm. Bye-bye, sir.