AccountId: 011433970860
ContactId: d722eb7e-5755-403c-a200-3ec69c7a48d7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 188669 ms
Total Talk Time (AGENT): 99552 ms
Total Talk Time (CUSTOMER): 55669 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=1.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2024/12/31/d722eb7e-5755-403c-a200-3ec69c7a48d7_20241231T15:24_UTC.wav
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[AGENT][NEUTRAL] Calling APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, I'm calling to uh verify eligibility and benefits for a patient that's in office.
[AGENT][NEUTRAL] OK, and your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK. And what's the policy number, [PII]?
[CUSTOMER][NEUTRAL] 025555-14.
[AGENT][POSITIVE] And a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And you're checking eligibility and did you say office visit benefit?
[CUSTOMER][NEUTRAL] Uh, just a general benefits.
[AGENT][NEUTRAL] OK, what type of service?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Mm preventative, basic and major?
[AGENT][NEUTRAL] OK, so the policy effective date is [PII]. I show the policy is active at this time.
[AGENT][NEUTRAL] OK, you are a dental provider. OK.
[CUSTOMER][NEUTRAL] You said?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Understand that now.
[AGENT][NEUTRAL] So under this policy, it covers preventive and basic only. Of course, preventive is reimbursed at 8 at 100%. Basic is reimbursed at 80%. Ma is not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, I do not show any claims on file for this patient.
[AGENT][NEUTRAL] Um, did you need the frequencies or did you want the schedule faxed to you?
[CUSTOMER][NEUTRAL] That's fine. You can fax it.
[AGENT][NEUTRAL] OK, and what is your fax number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. It, it, it will, it's about 5 pages including the cover page. It'll have the calendar max deductible information.
[AGENT][NEUTRAL] Uh, the percentage level which has been provided, the frequencies, common limitations and exclusions, and then it'll provide you with the payer ID number, claims mailing address and a fax number and also each code that's covered under the plan is listed as well. So if you do not see the the the the CDT code or the procedure code, it's not covered by this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, and is ortho is ortho I'm assuming ortho is not covered?
[AGENT][NEUTRAL] That is correct. That's one of the exclusions that you'll see.
[CUSTOMER][POSITIVE] OK perfect all right uh well thank you so much for your help.
[AGENT][POSITIVE] Oh, you're welcome, uh, [PII]. Anything else I can help with today?
[CUSTOMER][NEUTRAL] I don't watch it.
[AGENT][POSITIVE] Alrighty, you should receive the schedule within the next 5 to 7 minutes.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][POSITIVE] All [PII]. You too, and thank you for calling APL. Have a good day and holiday.
[CUSTOMER][POSITIVE] Have a good day.
[CUSTOMER][POSITIVE] Thank you bye bye.