AccountId: 011433970860
ContactId: cfbf4e11-8d8c-4949-9fd7-863e9d6e0c7e
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 436119 ms
Total Talk Time (AGENT): 152289 ms
Total Talk Time (CUSTOMER): 110391 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/19/cfbf4e11-8d8c-4949-9fd7-863e9d6e0c7e_20250519T14:51_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes hi calling from provider's office. I need to verify patients benefits.
[AGENT][NEUTRAL] Sure, can I get your name?
[CUSTOMER][NEUTRAL] So a series.
[AGENT][POSITIVE] And a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. All right. And can I get the policy number?
[CUSTOMER][NEUTRAL] Sure, so it's gonna be.
[CUSTOMER][NEUTRAL] 02569266
[AGENT][NEUTRAL] OK, one moment while I look that up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Can I get you to verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], uh, it's [PII].
[AGENT][POSITIVE] Great thank you so much.
[AGENT][NEUTRAL] I'm showing that this policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] And I'm so sorry
[CUSTOMER][NEUTRAL] Are we in network?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Who are you calling from?
[CUSTOMER][NEUTRAL] This is Odell Dental for Doctor [PII]. Do you need a tax ID number to verify?
[AGENT][POSITIVE] No, no, ma'am. I'm so sorry.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] So we don't go through specific PPOs, so what we do is um if they go through you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And you deny the claim as long as it was services that is accepted under their policy, they will be able to file the claim and then we will honor those services, uh, honor those payments as long as it was under their um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Policy, and then we do go through the Carrington network as well. So I don't know if you're within the Carrington network.
[CUSTOMER][NEUTRAL] OK, so you're not at this point you can tell me whether we are in network or out of network or this patient has out of network coverages, anything like that?
[AGENT][NEUTRAL] Right, if they are out, if you are out of network, they would be able to file the claim, but you can file through us first. Let me double check.
[CUSTOMER][NEUTRAL] OK, so I'll, yeah.
[CUSTOMER][NEUTRAL] We need to know if it's out of network or not.
[AGENT][NEUTRAL] OK, give me just a second.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] You said [PII]?
[CUSTOMER][NEUTRAL] It's Odell Dental.
[CUSTOMER][NEUTRAL] It's for Doctor [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And can I get the zip code and I can see.
[CUSTOMER][NEUTRAL] [PII] again it's [PII].
[AGENT][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] OK, on my end, I am showing that it is out of network.
[CUSTOMER][NEUTRAL] OK, now does this patient have out of network coverages or no?
[AGENT][NEUTRAL] Yes, so should you deny it they can they can file the claim themselves right and then we will be able to.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[AGENT][POSITIVE] To honor that as long as it was in their po the the services that they were getting were under our network or under their policy. I'm so sorry.
[CUSTOMER][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] OK, so I'm gonna note that we are out of network. Patient does have out of network coverages, correct?
[AGENT][NEUTRAL] Right, um, and would you like a oh go ahead.
[CUSTOMER][NEUTRAL] OK, now the patient uh.
[CUSTOMER][NEUTRAL] Yeah, go ahead.
[AGENT][NEUTRAL] I was going to say we can I can provide you a fax back with all of the expenses that they do have covered and it looks like this particular policy goes through UCR if that's helpful.
[CUSTOMER][NEUTRAL] Go ahead.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, let me make a note on that so it does go through UCR.
[AGENT][POSITIVE] Correct, ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And would you like me to send you a fax back as well?
[CUSTOMER][NEUTRAL] Um, is this something that you can email?
[AGENT][POSITIVE] Yes, I should be able to email that to you.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] It's [PII] again it's [PII].
[AGENT][NEUTRAL] And it's [PII], correct?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Oh, OK, OK.
[CUSTOMER][POSITIVE] OK thanks.
[AGENT][NEUTRAL] Alright, [PII].
[CUSTOMER][NEUTRAL] Now in this case um can patient send out a claim and then he gets his own reimbursement that way?
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Right, it's whoever files the claim first.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, got it.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] And then he can send it to [PII] yeah?
[AGENT][NEUTRAL] Yes, [PII]. Yes, ma'am.
[CUSTOMER][POSITIVE] Got it, yeah.
[AGENT][NEUTRAL] Alright, I will send this um fax back to you through email.
[AGENT][NEUTRAL] Um, give it 5 to 10 minutes, uh, just in case, and, uh, I would check your spam just in case if you don't see it within that time frame.
[CUSTOMER][POSITIVE] Mhm thank you so much.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][POSITIVE] OK, got it, thank you so much. Can I get your name please?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][POSITIVE] OK, thank you so much have a good day.
[AGENT][POSITIVE] Alright, you have a great day. Thank you for calling ATL.
[CUSTOMER][POSITIVE] Great thank you