AccountId: 011433970860
ContactId: d4f62a8f-4a0e-4117-80a8-cebe8e940605
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 493299 ms
Total Talk Time (AGENT): 244732 ms
Total Talk Time (CUSTOMER): 117811 ms
Interruptions: 1
Overall Sentiment: AGENT=0.4, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/29/d4f62a8f-4a0e-4117-80a8-cebe8e940605_20250429T15:07_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling ATL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII]. I'm calling from a provider's office. Um, I'm unfamiliar with this, um, insurance, and I'm trying to get benefits for the patient coming in.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, sure, I can assist you with benefits and Ms. [PII], what's the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] Arquatex oral Surgery.
[AGENT][NEUTRAL] All right, and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] 603-731
[AGENT][NEUTRAL] And what's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Perfect. Thank you. Good. All right, so this is one of our um dental policies. This one pays a flat amount based on the coding. Um, do you need to check some codes with me?
[CUSTOMER][POSITIVE] Oh yes, because I don't know anything about it, so I'm gonna need all of it um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] OK. We also have a faxed back if you need it, it's fine. Um, let me go ahead and just pull that information really quick.
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] What is the group number for this policy?
[AGENT][NEUTRAL] OK, I think this one doesn't have one, but let me double check, OK.
[AGENT][NEUTRAL] Yeah, this is one of our old policy um let's see.
[AGENT][NEUTRAL] OK, so it looks like it's showing group LA 0146.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] It's a self-pay policy.
[CUSTOMER][NEUTRAL] Alright
[AGENT][POSITIVE] OK, and I'm ready for the codes.
[CUSTOMER][NEUTRAL] OK, um, where I see.
[CUSTOMER][NEUTRAL] 7140.
[CUSTOMER][NEUTRAL] 70 to 10.
[CUSTOMER][NEUTRAL] Do you want me to give you all of them or?
[AGENT][NEUTRAL] Um, if you don't mind one by one, I can go ahead and search it a little bit better if it's one by one. so 7140 is not a covered service or it's not listed under the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's not listed on the policy.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That's just a basic extraction, so I, uh, what about 70 to 10?
[AGENT][NEUTRAL] 7210, let's see.
[AGENT][NEUTRAL] OK, 70 to 10 is cover. 70 to 10 is going to be, and again, this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer. It looks like we paid $30 for $70 to $10.
[CUSTOMER][NEUTRAL] OK, and then 7220.
[AGENT][NEUTRAL] So when they do 20 that pays 55.
[CUSTOMER][NEUTRAL] OK, and then I have a 7230 or 7240. It's just, you know, they're all impacted with some teeth.
[AGENT][NEUTRAL] OK, so that's gonna be 7230 and um let me see, 7240. The 7230, it pays 74, and then the 7240 pays 85.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] What about 0330?
[AGENT][NEUTRAL] OK, 0330. Here is a panel and that's going to be, looks like it pays $30. I'm sorry, it looks like it pays $35.
[CUSTOMER][NEUTRAL] OK, um, are they eligible for a pano?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] Let me check the history. One moment.
[AGENT][NEUTRAL] OK, so the last panel I got here was [PII]. Um, let me see how long on this one.
[AGENT][NEUTRAL] Very
[AGENT][NEUTRAL] it's a little bit different so let me see.
[AGENT][NEUTRAL] Um, and then you know because.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so under this policy, it looks like this one is gonna be every 3 years. So she did it on [PII]. So yeah, it looks like she's due for one.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And are there any accumulations for um a deductible or max?
[AGENT][NEUTRAL] OK, let me check.
[CUSTOMER][NEUTRAL] What what are they?
[AGENT][NEUTRAL] Remaining balance on that.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] I wonder why there's coverage for impacted wisdom teeth, but not for a simple extraction.
[CUSTOMER][NEUTRAL] That's odd. Usually it's the other way around.
[AGENT][NEGATIVE] Uh no.
[AGENT][NEUTRAL] Yeah and sometimes um well this one just pay a flat amount but.
[AGENT][NEUTRAL] Sometimes you can send a claim and it could be paid. They just need to research it, but it is not listed, so I cannot, you know, guarantee that it's gonna be paid because it's not listed on the schedule of benefits.
[AGENT][NEUTRAL] But um yeah, if there's been any changes or anything like that, it, it will go ahead and process them, you know, right now it's just not listed.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, so she has not used her benefits as of today for [PII]. So she still have the $1000 left and she has not met her deductible of $50.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] And what are the effective dates of this policy? Is it calendar, fiscal, monthly?
[AGENT][NEUTRAL] Um, this one is a calendar year plan based on the benefits, and this one effective date is [PII].
[CUSTOMER][NEUTRAL] What is?
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][NEUTRAL] OK, um, I think that's it, um, just a call reference number please.
[AGENT][NEUTRAL] We don't have reference numbers you can use my name in today's date if you will. Do you need to spell my name?
[CUSTOMER][NEUTRAL] I'm so sorry you cut out.
[AGENT][NEUTRAL] Um, for the reference, we don't have reference numbers. You can use my name in today's date. Would you like the spelling of my name or any other information?
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] OK. Sure. That's [PII].
[CUSTOMER][POSITIVE] All right, I appreciate your help. Thank you very much.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good day.
[CUSTOMER][POSITIVE] You as well thank you.
[AGENT][POSITIVE] Thank you. You're welcome.