AccountId: 011433970860
ContactId: d2e8a5de-2b06-4e57-b9a1-570228f43ca9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 308010 ms
Total Talk Time (AGENT): 128675 ms
Total Talk Time (CUSTOMER): 107974 ms
Interruptions: 2
Overall Sentiment: AGENT=1.1, CUSTOMER=-0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/25/d2e8a5de-2b06-4e57-b9a1-570228f43ca9_20250225T20:15_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from my dental provider office. I'm calling to see if I can get um.
[CUSTOMER][NEUTRAL] Eligibility on two procedure codes for a patient of mine.
[AGENT][POSITIVE] OK, well, I'll be more than happy to assist you with the cold and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes ma'am, it is [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] Yes, um, the member ID is 02013730.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yes, the patient's name is [PII], sorry, and her date of birth is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. I am showing the policy is active, it's been effective since [PII].
[AGENT][NEUTRAL] And um what were the two codes that you needed help with?
[CUSTOMER][NEUTRAL] D 0 150 and D02 10.
[CUSTOMER][NEUTRAL] I just like getting this over.
[AGENT][NEUTRAL] Um, D 0150 and what was the other?
[CUSTOMER][NEUTRAL] D0150 and D0210.
[AGENT][NEUTRAL] OK, hold on one moment.
[AGENT][NEUTRAL] OK, so 00150 is under preventative at 100%, um.
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] It's the evaluation, so it's 2 for 12 month period.
[AGENT][NEUTRAL] That can be paired with um
[AGENT][NEUTRAL] Hold on one second. 120, 140, 150, 160, or 180?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, so 150 and 210 are covered in 100%.
[AGENT][NEUTRAL] Well, I just did that one. I'm gonna go to 210 next.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 210 is under radiographs and FMX which is 80%.
[CUSTOMER][NEUTRAL] a
[AGENT][NEUTRAL] And it's limited to one x-ray procedure per 5-year period. It's paired with 0277 and 0330.
[CUSTOMER][NEGATIVE] That doesn't work.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, is there any history?
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Be at the Veterans Memorial.
[AGENT][NEUTRAL] Um, let me see if there's a, there is a claim here that was just received on the [PII], but it's in processing, so let me see if there's a way I can access it.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] To see what codes are on there. Hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEGATIVE] That's that's no thanks.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Yeah, it's
[CUSTOMER][NEUTRAL] This
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Hold on one moment, it's coming up.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] Oh my goodness, it's just loading. OK, here we go.
[CUSTOMER][NEUTRAL] He is over that um Veterans.
[AGENT][NEUTRAL] Um, the code on the claim that is pending is D0150,0220,0230 D0274, D0330.
[AGENT][NEUTRAL] D1110 and [PII].
[AGENT][NEUTRAL] So that will be the history.
[CUSTOMER][NEUTRAL] Mm, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, also, just to confirm, this is a PPO insurance.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] On [PII].
[AGENT][NEUTRAL] Um, this policy is not on the network, as in PPO HMO. It's just a, a standard Carrington fee schedule.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Oh, OK. OK, ma'am, um, that'll be it for today then.
[AGENT][POSITIVE] Alrighty. Well, thank you so much for calling APL. I hope you have a great day.
[CUSTOMER][POSITIVE] You too, well, thank you, ma'am, for your help. Thank you, ma'am. Bye bye.
[AGENT][POSITIVE] Thank you, [PII]. You're welcome. Bye-bye.
[AGENT][NEUTRAL] Wait, cause I'm not trying to get behind.