AccountId: 011433970860
ContactId: d64da3ec-03fc-419a-868e-9f0f4329f60f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 293200 ms
Total Talk Time (AGENT): 109645 ms
Total Talk Time (CUSTOMER): 99305 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/d64da3ec-03fc-419a-868e-9f0f4329f60f_20250210T18:34_UTC.wav
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[AGENT][NEUTRAL] For calling APL, my name is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] Hi, I was calling in regards to a patient, um, that is gonna get seen here at our dental office, and I just wanted to verify the dental coverage.
[AGENT][POSITIVE] OK, I'll be happy to assist with the eligibility. May I have your first name please?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] And [PII], if I can get a good call back number for you?
[CUSTOMER][NEUTRAL] [PII] option 2.
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] 02579779
[AGENT][NEUTRAL] Hello.
[CUSTOMER][NEUTRAL] Yes, can you hear me?
[AGENT][NEUTRAL] Yes, I asked for the policy number.
[CUSTOMER][NEUTRAL] Yeah, did you not hear me?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] OK, it's 025797779.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of is not a guarantee of payment. I do show the policy is currently active. Effective date is [PII]. And were you needing a fax back down of the benefits?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Well, first I needed to figure out what the fee schedule name was.
[AGENT][NEUTRAL] It's UCR user and customary.
[CUSTOMER][NEUTRAL] Um, is there different in something like
[CUSTOMER][NEUTRAL] I don't have anything under that UCR.
[AGENT][NEUTRAL] I'm sorry, repeat that.
[CUSTOMER][NEUTRAL] Can you hear me or no?
[AGENT][NEUTRAL] What did you just say? I couldn't hear you. It's like you're going in and out.
[CUSTOMER][NEUTRAL] The name of the carrier like where we file claims, is there a different name besides the UCR because I don't have that on here.
[AGENT][NEUTRAL] UCR is a user and customary rates for your area since we don't have a network.
[CUSTOMER][NEUTRAL] So we're not in network with the insurance then?
[AGENT][NEUTRAL] Yes, we don't have a network. The patient can go to any provider they choose and you would go by the UCR, the user and customary rates for your area for billing.
[CUSTOMER][NEUTRAL] OK, I wouldn't be able to put her insurance in with that. Is there anything else?
[CUSTOMER][POSITIVE] I like a UFC local.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Mm mm, I don't know. There's nothing else to put in. There's nothing to put in.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] What's the claims address?
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And that's in [PII] City, [PII].
[CUSTOMER][NEUTRAL] OK and then what is it?
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] OK, and the individual deductible and max?
[AGENT][NEUTRAL] Deductible is 50, maximum is 1500.
[CUSTOMER][NEUTRAL] And then um there are orthodontics coverage?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] And then what's the good coverage for diagnostic preventative or is it all covered like?
[CUSTOMER][NEUTRAL] Um, endoperio oral surgery, implant dentures, counts bridges.
[AGENT][NEUTRAL] Implants are not covered. Um, did you want me to fax you over the fax back?
[AGENT][NEGATIVE] But implants are not covered.
[CUSTOMER][NEUTRAL] Um, no, I just needed like the frequencies.
[AGENT][NEUTRAL] So preventative is covered at 100%, basic is covered at 80, major is covered at 40, and there is a waiting period, so she wouldn't be eligible for major services until [PII].
[CUSTOMER][NEUTRAL] There's only 11 codes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, and then, um, I have 11 codes to be specific. Did you want them all at once or one by one?
[AGENT][NEUTRAL] No, we don't do coding verbally. I'll have to fax you the fax back. If the code is not on the fax back, that means it's not covered.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And then through those questions, um, is there any downgrades or predetermination mandatory?
[AGENT][NEUTRAL] We don't do downgrades and it's not mandatory.
[CUSTOMER][NEUTRAL] OK and then did you want the fax number?
[AGENT][POSITIVE] I'm ready.
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] You should receive that within the next 5 to 10 minutes. Was there anything else I could assist with today?
[CUSTOMER][POSITIVE] That was all thank you.
[AGENT][POSITIVE] Thank you for calling APL. Have a good day.