AccountId: 011433970860
ContactId: d91f1e02-28d4-45a1-aef2-f2e269ee09ca
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 177880 ms
Total Talk Time (AGENT): 102712 ms
Total Talk Time (CUSTOMER): 74614 ms
Interruptions: 4
Overall Sentiment: AGENT=1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/d91f1e02-28d4-45a1-aef2-f2e269ee09ca_20250115T16:16_UTC.wav
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[AGENT][NEUTRAL] APL, this is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Good morning [PII]. My name is [PII]. I'm calling to see if a patient is active and get a fax back for benefits.
[AGENT][NEUTRAL] OK, I can assist you, [PII]. What's the policy number?
[CUSTOMER][NEUTRAL] It's 600024.
[AGENT][NEUTRAL] And what's a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII], there's no extension.
[AGENT][NEUTRAL] OK, and what's your fax number?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you. What's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII], date of birth is [PII].
[AGENT][POSITIVE] Alright, thank you for verifying that information, [PII].
[AGENT][NEUTRAL] So I show the policy effective date is [PII].
[AGENT][NEUTRAL] [PII], this policy is active at this time, and the schedule will include the calendar year maximum.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The frequencies, uh, the calendar, your deductible, the common limitations and exclusions, um, it will provide each procedure code that's covered under the policy.
[AGENT][NEUTRAL] Um, the very bottom will list the, uh, the limitations as far as frequencies and then, you know, certain codes share frequencies that'll be um at the very bottom of the last page.
[CUSTOMER][NEUTRAL] benefits claim.
[CUSTOMER][NEUTRAL] Mhm OK.
[AGENT][NEUTRAL] Um, our claims mailing address, fax number and payer ID number is also listed um on the document and uh let's see, there is, well, the 12 month waiting period is, is already met due to the effective date and so.
[CUSTOMER][NEUTRAL] Up
[CUSTOMER][NEUTRAL] OK, and what was the waiting period for the 12 month waiting period?
[AGENT][NEUTRAL] It's, it's, it's for major services only.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then um this is a fee schedule correct? Is that gonna be on the 5?
[AGENT][NEUTRAL] Uh huh, so preventive is reimbursed at 100% of UCR, basic 80% of UCR, and major is 40%. Uh, give me just a second.
[CUSTOMER][NEUTRAL] Welcome
[CUSTOMER][NEUTRAL] recorded for quality assurance.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Press 1 for any other inquiries press 2.
[AGENT][POSITIVE] Uh, my apologies, it's gonna pay a certain benefit for each procedure code.
[AGENT][NEUTRAL] Under this particular policy.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][POSITIVE] OK perfect.
[AGENT][POSITIVE] And you should receive the schedule within the next 5 to 7 minutes. And did you have any other questions I could help out with today, Zela?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, no, that will be all. Is there a reference number for our call?
[AGENT][NEUTRAL] My name in today's date, [PII]
[AGENT][NEUTRAL] First initial last name is [PII].
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] OK perfect thank you so much.
[AGENT][POSITIVE] You're welcome. Thank you for calling ATL. Have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.