AccountId: 011433970860
ContactId: cd355aa4-a11c-4048-a2c1-dc8a5183127f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 383239 ms
Total Talk Time (AGENT): 169231 ms
Total Talk Time (CUSTOMER): 121918 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=2.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/07/cd355aa4-a11c-4048-a2c1-dc8a5183127f_20250307T19:44_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. Good afternoon. My name is [PII], calling on behalf of the provider's dental office to check eligibility and benefits for a patient on a recorded line. Could you please help me with that?
[AGENT][POSITIVE] Sure, I'll be more than happy to help you with the eligibility and benefits. And [PII], may I have a good contact number in case we disconnected? You're welcome.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Sure. Callback number is [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Sure. The number will be 02441228.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure, uh, patient's name is [PII]. Date of birth would be [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. I am showing that the policy is active. It's been effective since [PII].
[AGENT][NEUTRAL] And did you need a copy of the fax bag sent to you or you have particular questions about the fax back?
[CUSTOMER][NEUTRAL] Uh, no need, uh, and, uh, I have specific questions. Uh, could you please help me over the call? OK.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much. May I know the group number and group name, please?
[AGENT][NEUTRAL] Yes, hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] The group number is 26107.
[AGENT][NEUTRAL] And the group
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The group name is Universal Trucking.
[AGENT][NEUTRAL] Usher Transport.
[CUSTOMER][POSITIVE] Perfect. Thank you so much. May I know the annual max deductible and use amount, please?
[AGENT][NEUTRAL] The calendar year max is $1500. The deductible is $50 per covered insured up to $150 per family, and it does not apply to preventative services. And let me see.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] And let me, I'm looking for the usage. Hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEGATIVE] And for [PII], none of the max has been used, nor has the deductible been met.
[CUSTOMER][POSITIVE] Perfect. Thank you so much. And may I know the providers network participation please for this plan or is there any reschedule?
[AGENT][NEUTRAL] It's a standard Carrington fee schedule. There's no provider network.
[CUSTOMER][POSITIVE] OK, noted. OK. Thank you so much. And uh may I know the coinsurance please for diagnostic, preventive basic and major services?
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] So preventative, the policy um covers at 100% of UCR, radiograph, FMX, basic, and basic restorative are all at 80%.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Major, which includes endodontic, periodontic, proteodontic, and oral surgery are all at 40% with the 12-month waiting period.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Awesome.
[CUSTOMER][POSITIVE] All right. Thank you so much, [PII]. Is there any history for this patient for preventive imperial services?
[AGENT][NEUTRAL] Um, so for this member, let me see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Hm, how can I do this? Do you have particular codes that you want to check? I'll have to go through each of the claims to see if there's history. Do you have like a list of codes you want me to go through?
[CUSTOMER][NEUTRAL] Yes, and
[CUSTOMER][NEUTRAL] Yes, I have the codes. I go with the code solid ones, I have around 9 codes.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Thank you. All right, codes are the 0274.
[CUSTOMER][NEUTRAL] The 0210.
[CUSTOMER][NEUTRAL] 0330
[CUSTOMER][NEUTRAL] 0120
[CUSTOMER][NEUTRAL] 0140 1110.
[CUSTOMER][NEUTRAL] 43414 4 quartz 41,910 and last would be D 4355. That's it.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] So, uh, well, let me do it this way. This will be easy. Hold on one second.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] So for 00274, the last day of service was [PII].
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] 00210 [PII].
[CUSTOMER][POSITIVE] I'm so sorry. Could you please repeat the history for the 0210? Once again, sorry for that.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Perfect. Thank you so much.
[AGENT][NEUTRAL] You're welcome. Um, there's no history on file for 0330?
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] For
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] 00120, um [PII].
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] 00140, no history on file?
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] Um, 01110 [PII].
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Um, no history on file for 4341.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] Um, no history on file for 04910.
[AGENT][NEGATIVE] And no history on file for 4355.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Awesome. That's perfect. Thank you so much, [PII]. I'm done with my questions. May I know the call reference number, please?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name and today's date. The first initial to my last name is [PII], and then today's date.
[CUSTOMER][POSITIVE] That's perfect. Thank you so much for your assistance, and uh. Have a wonderful day. Bye for now.
[AGENT][POSITIVE] You're welcome, [PII]. Was there anything else I can assist you with today?
[CUSTOMER][POSITIVE] No, and I'm done with my questions. Thank you so much for that.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Have a great day. Bye bye.
[CUSTOMER][NEUTRAL] Bye-bye.