AccountId: 011433970860
ContactId: be622f39-d0ca-4536-8343-548a825b8dad
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 391470 ms
Total Talk Time (AGENT): 122882 ms
Total Talk Time (CUSTOMER): 189366 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/13/be622f39-d0ca-4536-8343-548a825b8dad_20250613T22:01_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thanks for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon, my name is [PII]. I'm calling to see if I can get a verbal breakdown for a patient.
[AGENT][NEUTRAL] OK, and I can verify benefits for you. And I'm sorry, you said your name is [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, and what is that policy number, please?
[CUSTOMER][NEUTRAL] Um, the policy number is 02611218.
[AGENT][NEUTRAL] Thank you, ma'am. And one moment. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yes, it is uh [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, I'm showing his effective date is [PII]. He is active on the policy.
[CUSTOMER][NEUTRAL] I'm sorry, can you slow down?
[CUSTOMER][NEUTRAL] [PII] what?
[AGENT][NEUTRAL] Of 25.
[CUSTOMER][NEUTRAL] 25, is this a yearly max? Mhm OK.
[AGENT][NEUTRAL] And he is active.
[CUSTOMER][NEUTRAL] What is his yearly max?
[AGENT][NEUTRAL] Um, not a guarantee of payment, just verification and coverage. He has a benefit max of 500 per calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 100 per calendar year.
[CUSTOMER][NEUTRAL] OK, um, what is the name of this insurance? I'm sorry?
[AGENT][NEUTRAL] APL and also he does have a $50 deductible that applies to everything but preventative.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so give me one second, APL you said APL?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, OK, let me see, and the employer's name is [PII]?
[AGENT][NEUTRAL] Uh, see, yes.
[CUSTOMER][NEUTRAL] OK, what is this remaining balance?
[AGENT][NEUTRAL] Uh, he hasn't used his, uh, any of his benefits, nor me his deductible, so it is available.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, let me see, so I'll do, OK, what's the member ID?
[AGENT][NEUTRAL] 261-1218.
[CUSTOMER][NEUTRAL] 665568 OK OK.
[CUSTOMER][NEUTRAL] Uh, let me see, do you have the, uh, payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] 201. OK, so for examine and profy apply to the max.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, uh, X-ray applied to the max.
[AGENT][NEUTRAL] Yes, all services apply to the Benefit Max.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Exam 86 a month. OK, let me see, uh, basic is covered at what percentage?
[AGENT][NEUTRAL] Uh, basic is at 80% of UCR.
[CUSTOMER][NEUTRAL] 86 80% and um preventative.
[AGENT][NEUTRAL] I, I said 100% VCR.
[CUSTOMER][NEUTRAL] 100 OK and major?
[AGENT][NEUTRAL] Mhm
[AGENT][NEGATIVE] Uh, it's not covered.
[CUSTOMER][NEGATIVE] Not covered, not covered.
[CUSTOMER][NEUTRAL] OK, and you said deductible hasn't been met, uh, what is the deductible?
[AGENT][NEUTRAL] $50 that is applied to everything but preventative.
[CUSTOMER][NEUTRAL] Deductible is.
[CUSTOMER][NEUTRAL] $50 and it applies to what I'm sorry?
[AGENT][NEUTRAL] Everything but preventative services.
[CUSTOMER][NEUTRAL] OK, um, everything but preventative services, OK, let's see.
[CUSTOMER][NEUTRAL] Is there any way you can um send me a fax or if I can get um.
[CUSTOMER][NEUTRAL] Emailed
[AGENT][NEUTRAL] Uh, I can fax back to you. Uh, what's your fax number?
[CUSTOMER][NEUTRAL] Like a breakdown.
[CUSTOMER][NEUTRAL] No. Yes, fax number is, give me one second, [PII].
[CUSTOMER][NEUTRAL] 8850.
[AGENT][NEUTRAL] OK, and that's [PII].
[CUSTOMER][POSITIVE] Correct.
[AGENT][POSITIVE] OK, I will send this off to you in a few moments. Uh, is there anything else I can assist you with?
[CUSTOMER][NEUTRAL] OK, and what is that?
[CUSTOMER][NEUTRAL] Yes, um, the PO box address, the claims address.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] [PII], [PII].
[CUSTOMER][NEUTRAL] [PII], uh huh.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] 8950.
[CUSTOMER][NEUTRAL] 950. OK, let me take a look and see what else is oral or oral surgery a covered benefit? You said no, right? Oral surgery is not covered? OK. And what about period?
[AGENT][NEUTRAL] Uh, no, ma'am.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Uh, that's considered major, so it's not covered.
[CUSTOMER][NEUTRAL] OK, not covered and what about basic uh.
[CUSTOMER][NEUTRAL] For basic it's covered right? at 80%?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Uh, the posteriors composite, uh, covered? Do they downgrade?
[AGENT][POSITIVE] And they're covered and there's no downgrades.
[CUSTOMER][NEUTRAL] No downgrade, OK.
[CUSTOMER][NEUTRAL] OK, let me take a look and see if we need anything else. One second, OK? Thank you.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, thank you for holding and sorry, what was your name?
[AGENT][NEUTRAL] It's [PII] last initial [PII]
[CUSTOMER][POSITIVE] OK, thank you so much for your help. um, that would be it.
[AGENT][POSITIVE] Alright, you're welcome. Thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You as well bye bye.
[AGENT][NEUTRAL] Bye.