AccountId: 011433970860
ContactId: c6057bf9-226b-4b96-b0da-6d45db670aab
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 483549 ms
Total Talk Time (AGENT): 148801 ms
Total Talk Time (CUSTOMER): 123498 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/10/c6057bf9-226b-4b96-b0da-6d45db670aab_20250310T16:16_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] Yeah, hi [PII], this is [PII] here calling from Market Enterprise office. Uh, I need to verify the patient's eligibility and benefit details. Could you assist me regarding this?
[AGENT][NEUTRAL] May I have a callback number, please?
[CUSTOMER][NEUTRAL] I can see that the patient's callback sorry uh my callback number is [PII] and the rendering extension is [PII].
[AGENT][NEUTRAL] May I have the policy number?
[CUSTOMER][NEUTRAL] Uh it's 747709 is the policy number. And I can see uh uh see here the patient's first name is [PII] is the first name. Last name is [PII], [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you so much for verifying the policy, [PII]. You're calling in for eligibility and benefits. Would you like a fax back for this member?
[CUSTOMER][NEUTRAL] Uh, if you don't mind, I would like to go with the verbal. Could you assist me with the verbal, ma'am?
[AGENT][NEUTRAL] OK, we only have a limit of certain benefits that could be just given.
[CUSTOMER][NEUTRAL] Yeah, yeah, yeah, could you assist me with the deductibles and annual max for this patient's policy?
[AGENT][NEUTRAL] Yes, and for the member's eligibility, it does show that the policy is currently active. The effective date is [PII], and I'm pulling that member's benefits up for you now.
[AGENT][NEUTRAL] And verification of coverage does not guarantee the payment of the claim. For this member, the calendar year max is $1000 per calendar year, and then for the calendar year deductible, the member has up to $50 per cover insured.
[CUSTOMER][NEUTRAL] And is there any family deductible for this patient's policy?
[AGENT][NEUTRAL] This is an individual policy.
[CUSTOMER][NEUTRAL] Uh, could you assist me in the coins per day of preventative basic and measure.
[AGENT][NEUTRAL] OK, you're needing the preventative.
[CUSTOMER][NEUTRAL] When did you basically and major coinsurance?
[AGENT][NEUTRAL] So with this policy, this is not considered.
[AGENT][NEUTRAL] A contracted, I mean a.
[AGENT][NEUTRAL] How can I explain it? It is not considered like a major medical type policy. This policy is based off of
[AGENT][NEUTRAL] The contracted amount.
[AGENT][NEUTRAL] So in regards to preventative.
[CUSTOMER][NEUTRAL] OK, so I think
[CUSTOMER][NEUTRAL] Uh, it's in the contract period, so I need to confirm that's covered. Everything will be covered at 100% right for this patient's policy.
[AGENT][NEUTRAL] I'm pulling that information up for you now.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there a specific benefit that you're needing me to pull up or procedure code?
[CUSTOMER][NEUTRAL] 0120.
[AGENT][NEUTRAL] That's the prophylaxis for the child?
[CUSTOMER][NEUTRAL] 0120 is.
[AGENT][NEUTRAL] This is an adult.
[AGENT][NEUTRAL] Oh, you said 0120, OK.
[AGENT][NEUTRAL] And what was the next code?
[CUSTOMER][NEUTRAL] 2160.
[AGENT][NEUTRAL] And is there another code that you're needing me to pull up as well?
[CUSTOMER][NEUTRAL] 2160 and the 2740.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And verification of coverage does not guarantee the payment of this claim. For the preventative 0120, it is showing that it will be paid at $15 and for the 2160, it is showing that it would be paid at $35.
[AGENT][NEUTRAL] And for the 2740, it is showing that $215 will be the benefit amount.
[CUSTOMER][NEUTRAL] OK, and uh could you assist me with the group number or a group name?
[AGENT][NEUTRAL] The group number?
[CUSTOMER][NEUTRAL] Uh, there is no group.
[CUSTOMER][NEUTRAL] Is there uh there's a group number or group name or there is no group number or group name?
[AGENT][NEUTRAL] For this member it is showing that there is no group number or name.
[CUSTOMER][NEUTRAL] So it's an individual policy, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Uh, could you assist me with the effective date you have been stated that for this patient's policy will be started from [PII], right?
[AGENT][NEUTRAL] That is correct and it's currently active.
[CUSTOMER][NEUTRAL] OK, and uh we need to confirm these there any used, uh, could you go add the member ID which I provided to you is the current member ID.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, is there any waiting period for this patient's spot on?
[AGENT][NEUTRAL] For the procedure codes that you.
[AGENT][NEUTRAL] Request it
[CUSTOMER][POSITIVE] Uh, yes, that's right.
[AGENT][NEUTRAL] It is showing no waiting period.
[CUSTOMER][NEUTRAL] OK, and could you assist me with this any Kimla demand from the deductibles and annual max?
[AGENT][NEUTRAL] As of right now, it's not showing that the member has used any of their benefits.
[CUSTOMER][NEUTRAL] Yes just me the life the maximum for the orthodontics, so there is no orthoage for this patient's plan.
[AGENT][NEGATIVE] It is not showing that ortho is covered under this policy.
[CUSTOMER][NEUTRAL] OK, and is there any history for this patient's policy, which affects the frequency or is in a history for this year?
[AGENT][NEGATIVE] As I stated, the member has not used any benefits for the year of [PII].
[CUSTOMER][NEUTRAL] So then uh there's no history, right?
[AGENT][NEGATIVE] There's no benefits that's been used for this year.
[CUSTOMER][NEUTRAL] Could you assist with your call reference number, name and call reference number.
[AGENT][NEUTRAL] The call reference number would be my first name [PII], last initial of [PII] and today's date.
[CUSTOMER][POSITIVE] Thank you, thank you for providing valuable information. Have a nice day.
[AGENT][POSITIVE] You're welcome. Thank you for calling American Public Life, [PII], have a great day as well.