AccountId: 011433970860
ContactId: cb454fa1-4a31-4496-a8d1-332cb0e14bdb
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 732440 ms
Total Talk Time (AGENT): 175641 ms
Total Talk Time (CUSTOMER): 115481 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=-0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/21/cb454fa1-4a31-4496-a8d1-332cb0e14bdb_20250421T17:46_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I am looking to get one of my patients verified for an appointment he has tomorrow.
[AGENT][NEUTRAL] Of course, I can help you with verification or benefits today. Do you have the policy number?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] I do, um, give me one moment here let me pull it up.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I have 02288044.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, and then what's your name and a good callback number?
[CUSTOMER][NEUTRAL] My name is [PII]. Callback number is [PII].
[AGENT][POSITIVE] Perfect.
[AGENT][NEUTRAL] OK. And then the patient's first and last name and date of birth, please?
[CUSTOMER][NEUTRAL] First name is [PII]. Last name [PII]. Date of birth [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] OK, just one moment while I pull up his dental.
[CUSTOMER][POSITIVE] No worries.
[AGENT][NEUTRAL] Would you like me to fax you over the dental benefits?
[CUSTOMER][NEUTRAL] Um, you can, yeah, that'd be great so I can have it on file, but I also, um, wanna make sure about what he's coming in for. So he is coming in for posterior fillings. Do you guys downgrade on posterior fillings?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] So we do not downgrade.
[CUSTOMER][NEUTRAL] OK, and then we are a uh out of network office. Do you guys do UCR or MaxiO?
[AGENT][NEUTRAL] So we do use CR for this policy.
[CUSTOMER][NEUTRAL] OK, so let me go ahead and and um I just wanna make sure he is active and hasn't used anything this year.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Oh, of course.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so it looks like the policy is currently active. The effective date is [PII].
[AGENT][NEUTRAL] Uh, let me see if he's used anything.
[AGENT][NEUTRAL] OK, and it looks like he has used his benefits twice this year?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] OK, it looks like back in March, um.
[AGENT][NEUTRAL] He had
[AGENT][NEUTRAL] A couple X-rays.
[AGENT][NEUTRAL] A prophylaxis, um, a bite wing X-ray.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] Periodic oral examination.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Yeah, that's, that's it for [PII].
[CUSTOMER][NEUTRAL] What it says remaining for for as of today?
[AGENT][NEUTRAL] Um, I'm not sure. Let me put you on a brief hold, OK?
[CUSTOMER][POSITIVE] Sure thank you.
[AGENT][POSITIVE] Just one moment. Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Hi, thanks for holding.
[AGENT][NEUTRAL] OK, so it, sorry, hi, um, so, so it looks like he would have.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] For the calendar year deductible, he would have $100 left.
[AGENT][NEUTRAL] Um, for the deductible, but the deductible also does not apply to preventative expenses.
[CUSTOMER][NEUTRAL] OK, so what his maximum is still 1500 or?
[AGENT][NEUTRAL] Let's see, I reached out to a colleague. She hasn't, uh, messaged me back yet.
[AGENT][NEUTRAL] I'm still kind of new, so I'm unsure exactly how to like give you the exact amount he has left.
[AGENT][NEUTRAL] Um, can I call you back on that?
[CUSTOMER][NEUTRAL] Well, I mean, so what is.
[CUSTOMER][NEUTRAL] Well, I mean, does it show what his maximum is?
[AGENT][NEUTRAL] It does. Um, it says calendar year maximum is 1500 per covered insured.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And you said he's only gone seen once this year or 2 times this year or something like that?
[AGENT][NEUTRAL] Uh, twice this year. Um, I'm looking at his, um, his claim forms.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK, so just whatever, however much they you guys paid on those claims minus the 1500 is just what I would need to know the remaining maximum.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so it looks like.
[AGENT][NEUTRAL] Uh, let me subtract this really quick.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so it looks like he would have $1000 182 60 cents.
[CUSTOMER][NEUTRAL] OK, and you said his deductible is $100?
[AGENT][NEUTRAL] That is what he has left. He's, uh, we have already paid up to $50 so calendar year deductible is $50 per covered insured up to $150 per family. Mhm.
[CUSTOMER][NEUTRAL] Oh OK so.
[CUSTOMER][NEUTRAL] And he's met, he's met his already is what you're saying, yeah.
[AGENT][NEUTRAL] So he
[AGENT][NEUTRAL] Yes. Mhm.
[CUSTOMER][POSITIVE] OK, alright, well thank you very much that's all I needed to know I appreciate it.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Yeah. Do you want me to send you that fax back anyways?
[CUSTOMER][POSITIVE] Yes, yes, please.
[AGENT][NEUTRAL] OK, what is your fax number?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, and then I'll send that over right now.
[CUSTOMER][POSITIVE] Thank you very much.
[AGENT][POSITIVE] OK, yeah, thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] OK, bye.