AccountId: 011433970860
ContactId: dbbb5c18-840f-4905-9b86-636c382db605
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 406470 ms
Total Talk Time (AGENT): 145394 ms
Total Talk Time (CUSTOMER): 312633 ms
Interruptions: 22
Overall Sentiment: AGENT=0.8, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/dbbb5c18-840f-4905-9b86-636c382db605_20250520T14:04_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] I just want to uh verify patients eligibility and remaining benefits.
[AGENT][NEUTRAL] OK, you're just needing to get eligibility and to see what benefit, how much.
[CUSTOMER][NEUTRAL] Like we estimated Remaining mhm mhm.
[AGENT][POSITIVE] Of the benefit is remaining. Yes, ma'am. I can help you with that. And who am I speaking with?
[CUSTOMER][NEUTRAL] Their history this is [PII].
[CUSTOMER][NEUTRAL] 318.
[AGENT][NEUTRAL] And [PII], what's a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you and the member's policy number, please.
[CUSTOMER][NEUTRAL] 617-750.
[AGENT][NEUTRAL] And what type of policy are you calling about today, Lahey?
[CUSTOMER][NEUTRAL] Dental.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And any information that I provide for you will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][POSITIVE] You know, you guys go out on the whim and y'all choose your insurance and we do the absolute best to get it filed, provide all of the necessary information, and we do not have a huge amount of claim denials and.
[CUSTOMER][NEUTRAL] We do have is always.
[CUSTOMER][NEUTRAL] Do you have so are you on Medicare?
[AGENT][NEUTRAL] And any information will show that I do provide again will be a verification of benefits and not a guarantee of payment. So this policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Do you what's your money.
[CUSTOMER][NEUTRAL] Like your, your Medicare Medicare.
[CUSTOMER][NEUTRAL] OK, well, that's why I was asking. A lot of patients that are on Medicare have like an Aetna PPO Freedom plan or they have a Humana PPO.
[AGENT][NEUTRAL] And give me just a moment, and you're wanting to know for this calendar year, is that correct?
[CUSTOMER][NEUTRAL] Uh yes.
[AGENT][NEUTRAL] OK, so she still has her deductible to be met. And as of now, she still has a balance of $911 available.
[CUSTOMER][NEUTRAL] But your Blue Cross is an advanced Blue Cross Blue Shield.
[CUSTOMER][NEUTRAL] OK that's OK, um, and as far as her history, um.
[CUSTOMER][NEUTRAL] I just wanna look into that preventative history.
[AGENT][NEUTRAL] OK, just a moment so that I can check the codes for you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEGATIVE] Um, well, you can't change it with them because you know you're at their [PII] if you choose their plan, they're gonna pay what they wanna pay. They're just not.
[CUSTOMER][NEUTRAL] And there's not a lot of options um when it comes to individual dental plans that do pay well.
[AGENT][NEUTRAL] OK, and what is the first code you would like to check?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] 1110 if you choose to get um.
[CUSTOMER][NEUTRAL] 0120 01 at a time, OK, that's fine.
[AGENT][NEUTRAL] OK, OK. I'm gonna have to do them one at a time. Mhm.
[AGENT][NEUTRAL] OK, so the last date of service for the 11:10 is [PII]?
[CUSTOMER][NEGATIVE] Because I would hate to tell you this and then your doctors that you see on a regular basis.
[CUSTOMER][NEUTRAL] You know, not take that point.
[AGENT][NEUTRAL] And did you say 0120?
[CUSTOMER][NEUTRAL] So and the only other option is going through um a supplemental insurance. A lot of patients do it position.
[AGENT][NEUTRAL] Also 56.
[CUSTOMER][NEUTRAL] OK, 0274.
[CUSTOMER][NEUTRAL] Um, you can go.
[AGENT][NEUTRAL] 10:31 24.
[CUSTOMER][NEUTRAL] Alrighty and then 0210.
[CUSTOMER][NEUTRAL] Because I'm sure I know like um we get things in the mail all the time and.
[AGENT][NEUTRAL] 102 of 23.
[CUSTOMER][NEUTRAL] OK, last 1, 0330 OK.
[AGENT][NEUTRAL] 0330.
[AGENT][NEUTRAL] No history.
[CUSTOMER][NEUTRAL] Alright, let me see if I have any other questions let's see.
[CUSTOMER][NEUTRAL] Can you tell me if there's any coverage on code 0431? I might as well get the because it's, it's about $5 a month.
[AGENT][NEUTRAL] Let me pull up her benefit information.
[CUSTOMER][NEUTRAL] But they pay, you know, 100% of what they allow because they're supplemental, so it's gonna be like a fee schedule there and I just don't want you to read that and think, oh they're gonna pay 70% well they're gonna pay 70% of what they allow on the [PII].
[CUSTOMER][NEGATIVE] So whatever we charge, they're just gonna pay on their allowance.
[CUSTOMER][NEUTRAL] And any office is gonna balance to.
[CUSTOMER][NEGATIVE] I just don't want you to feel misled because.
[AGENT][NEUTRAL] And give me that code one more time please, [PII].
[CUSTOMER][NEUTRAL] 0431.
[AGENT][NEUTRAL] OK, that is not covered.
[CUSTOMER][NEUTRAL] Perfect. OK, that's what I thought. Just wanted to double check, and do you know if anything, mhm, uh, that's OK. Do you know if anything has changed with this plan, um, in the past year?
[AGENT][NEUTRAL] Yes ma'am, it's not sure and then [PII], if you all end up.
[AGENT][NEUTRAL] I'm sorry, go ahead.
[AGENT][NEUTRAL] No. No, ma'am, it has not.
[CUSTOMER][NEUTRAL] No, OK, alright, and what was she saying? mhm.
[AGENT][NEUTRAL] And then if you all do file a claim with her for her with us once the claim has been processed, we do have a portal in which you should be able to check claim status in.
[AGENT][NEUTRAL] And our website for that [PII] is located at [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yeah, um, I do have access like to the.
[AGENT][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] Uh, website I just don't have like there's not like a breakdown of benefits and stuff like that on there, yeah, OK.
[AGENT][NEUTRAL] No, you can't, that is for claim status. Mhm.
[CUSTOMER][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] All right. Well, is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Uh, that's everything I needed. Thank you.
[AGENT][POSITIVE] OK, well then you're very welcome and thank you again for calling ATL. I hope you have a great day.
[CUSTOMER][POSITIVE] Thanks you too bye bye.
[AGENT][POSITIVE] Yes ma'am thank you bye bye.