AccountId: 011433970860
ContactId: d4ae071c-4500-4465-833c-05e48703c0f4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 512320 ms
Total Talk Time (AGENT): 254707 ms
Total Talk Time (CUSTOMER): 219814 ms
Interruptions: 5
Overall Sentiment: AGENT=0.6, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/06/d4ae071c-4500-4465-833c-05e48703c0f4_20250206T16:42_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, hi, um, my name is [PII]. I'm calling from a dentist office. I have a patient, um, and he has uh dental coverage to you guys, but, um, I need to, uh, make sure we are in network with his plan and if we are, uh, what type of pre schedule we need to follow and benefits as well.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Absolutely. OK, I can check all of that information including benefits. Um, let me get the policy pulled up. I'll see what kind of plan he has. Um, first, [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure it's [PII].
[AGENT][NEUTRAL] OK, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] I have the member ID is 01991714.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you. And what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, thank you for verifying that [PII]. Uh, so this policy is active effective date was [PII] and um so this plan does not have a set network it just pays a percentage off of a UCR and then if you'd like I can send you uh the fax back that shows all the covered procedures and benefit information.
[CUSTOMER][NEUTRAL] OK, so how, how this plan works, I'm sorry, can you repeat that again?
[AGENT][NEUTRAL] Mhm yes no no no you're fine yes so it's not a part of a network um it goes off of UCR so it pays a percentage based off of UCR.
[CUSTOMER][NEUTRAL] Uh, over our UCR.
[AGENT][NEUTRAL] Right, yes.
[CUSTOMER][NEUTRAL] OK, so you, so it's in, and it well should we like um.
[CUSTOMER][NEUTRAL] Submit claims or anything like that or it's no like that.
[AGENT][NEUTRAL] Um, you could file the claims directly to us.
[CUSTOMER][NEUTRAL] OK, OK, so but you said that how do we know if we are in network? You said we're not in network or we are?
[AGENT][NEUTRAL] This plan does not is not a part of a network, so it's completely up to each provider to file the claims, right? You would just, um, yes, so whatever y'all have as your UCR, um, the specific procedures that would pay a percentage of that you'd file those claims, send them directly to us.
[CUSTOMER][NEUTRAL] So it's not part.
[CUSTOMER][NEUTRAL] If we
[CUSTOMER][NEUTRAL] OK, can I please have, um, can I please have a payer ID number?
[AGENT][NEUTRAL] Oh yes.
[CUSTOMER][NEUTRAL] Uh, also like a claiming address.
[AGENT][NEUTRAL] Mhm, yes, I've also got a fax number too uh so our payer ID is, of course, payer ID is 60801.
[CUSTOMER][POSITIVE] Yes thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK and then our mailing address is.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mailing address is [PII].
[CUSTOMER][NEUTRAL] Mhm go ahead.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that is in [PII] City, [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So it's [PII].
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] OK and.
[CUSTOMER][NEUTRAL] It's any like a like a group number or or group or like a group name what is the group name?
[AGENT][POSITIVE] I can get that for you mhm.
[AGENT][NEUTRAL] Of course, let's see OK the group name is Universal.
[AGENT][NEUTRAL] Trucking
[AGENT][NEUTRAL] Kennan, uh, it's K, oh sure, yes, Universal.
[CUSTOMER][NEUTRAL] I'm sorry, can you repeat that? You say Universal Universal?
[AGENT][NEUTRAL] Trucking
[CUSTOMER][NEUTRAL] Trucking like a T R A C K.
[AGENT][NEUTRAL] Uh, trucking, um, like semi trucks, so.
[CUSTOMER][NEUTRAL] Like uh the truck?
[AGENT][NEUTRAL] Yes, trucking.
[CUSTOMER][NEUTRAL] T R U C.
[AGENT][NEUTRAL] C K I N G.
[CUSTOMER][NEUTRAL] Trucking T TRU right?
[AGENT][NEUTRAL] Mhm, um,
[AGENT][NEUTRAL] Yes, yes, tracking, um, and then Keenan, so K E N A N.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Advantage.
[CUSTOMER][POSITIVE] OK, advantage.
[AGENT][NEUTRAL] Mhm. Universal Trucking, uh, Kenan Advantage.
[CUSTOMER][NEUTRAL] OK, and the group number please?
[AGENT][NEUTRAL] Mhm, it is 14774.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So he will just pay us our UCR fees and then we will submit um the claims on his behalf and um you guys will decide to reimburse not to patient.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] We would, um, if you're the one filing the claim, we would send that, uh, payment to you, the benefit payments to you, um, and then of course on the fax back I can send you, go ahead, sorry.
[CUSTOMER][NEUTRAL] Oh, so, so, OK.
[CUSTOMER][NEUTRAL] OK, OK, OK, so, so let me just get get it straight, so.
[AGENT][NEUTRAL] Of course.
[CUSTOMER][NEUTRAL] We charge the patient because we will have to charge the patient up front. He will pay upfront we will submit the claims to you and if you get us back, we will reimburse the patient.
[AGENT][NEUTRAL] Oh, I see. OK, so it really does depend. I know every provider's office does things differently um so if you have to charge him up front uh for all of the procedures you're not able to bill him.
[CUSTOMER][NEUTRAL] Yeah, no, no, we will, we always, um, uh.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] I see, um.
[CUSTOMER][NEUTRAL] We, they have to for anything they have to pay for the visit the same day and for surgery they will have to pay uh the before the surgery needs to be paid.
[AGENT][NEUTRAL] I see. OK, so that would completely be up to you and um [PII] uh however y'all want to do that the way that we work is whoever files the claim with us is where we will send that payment so y'all can file the claim or you can give him the information like the itemized statement and all of that uh with the procedure codes and he can file the claim if he chooses.
[AGENT][NEUTRAL] And then we can send the payment to him it would be however y'all want to handle that.
[CUSTOMER][NEUTRAL] OK, and it's also in.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Because we, we usually when people, um, uses like an out of network benefits, uh, we will submit the claims on their behalf and just put for claims and reimbursements to them to the patient.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Sure, I mean that's however y'all want to handle that mhm.
[CUSTOMER][NEUTRAL] OK, OK.
[AGENT][NEUTRAL] And did you, did you want me to go ahead and send you this fax box, [PII]?
[CUSTOMER][NEUTRAL] Yes, I understand.
[CUSTOMER][NEUTRAL] Yes, yes, just to have it, please, uh, my fax number is 813.
[AGENT][POSITIVE] Of course, yeah, it does show.
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Go ahead 813
[CUSTOMER][NEUTRAL] Uh, OK, 609-456-5.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and I would just put this to your attention?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, I'll go ahead and get that sent now um just so that you are aware it does all of the covered procedures are going to be listed if you're looking for a specific procedure code and you don't see it listed under the fax back that simply means it's not a covered procedure under this policy.
[CUSTOMER][NEUTRAL] OK, so whatever is in the fax is what is covered if it's not in there it's because it's not covered.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] That is correct, yes ma'am.
[CUSTOMER][POSITIVE] Got you.
[CUSTOMER][NEUTRAL] OK, OK, can I please have a call reference number and you say your name is [PII], right?
[AGENT][NEUTRAL] Uh, [PII], um, so the, yeah, reference number would just be my first name, last initial, and today's date. Uh, so my last initial is A. Was there anything else I could help you with, [PII]?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][POSITIVE] You take care.
[CUSTOMER][POSITIVE] Uh, no, that will be it. Thank you for your help. I appreciate it.
[AGENT][POSITIVE] OK, yeah, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Same for you thank you OK bye.
[AGENT][POSITIVE] Thank you bye bye.
[CUSTOMER][NEUTRAL] Bye bye.