AccountId: 011433970860
ContactId: dd3f57ad-5464-45a6-b43d-460be61a07c4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 609140 ms
Total Talk Time (AGENT): 163210 ms
Total Talk Time (CUSTOMER): 150285 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/21/dd3f57ad-5464-45a6-b43d-460be61a07c4_20250321T14:09_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII]. I'm calling from providers office to check the eligibility and benefits. This call will be recorded for quality and training purposes.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, [PII], I can help you with eligibility and benefits, sir. Can you please give me your callback number and the name of the facility you're calling from?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Sure. My callback number is [PII].
[CUSTOMER][NEUTRAL] And my dentist, sorry, facility name, Lowry Modern Dentistry.
[AGENT][POSITIVE] OK, thank you so much. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yeah, the policy number is 024.
[CUSTOMER][NEUTRAL] 313
[CUSTOMER][NEUTRAL] 90
[CUSTOMER][NEUTRAL] And the patient's name, [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, I do show that this policy is no longer active. The policy lapsed on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]. Thank you so much for that information. Actually, uh, I need to resubmit a claim for [PII]. So, could you please help me to verify the benefits and eligibility for this patient?
[AGENT][NEUTRAL] The uh the effective date of the policy was [PII] and then it terminated on [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Thank you. And uh what is the group name and the group number for that policy?
[AGENT][NEUTRAL] The group number is 70,030 and the group name is Creative Circle.
[CUSTOMER][POSITIVE] Thank you so much. And uh for this policy, what will be the maxim, what was the maximum and the deductibles?
[AGENT][NEUTRAL] OK, let me look.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] A
[AGENT][NEUTRAL] Come
[AGENT][NEUTRAL] Just a moment while I pull that in.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, and this is just to verify benefits. It's not a guarantee of payment. The calendar year maximum was $750 per covered person and the calendar year deductible was $50 up to $150 for family.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][POSITIVE] Thank you so much. And does this policy having uh missing tooth clothes and waiting period at that time?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Thank you so much. And uh for this policy, could you please check what, what will be the coverage percentage of diagnostic preventative, basic, and major services?
[AGENT][NEUTRAL] OK, um, preventative is 100% of allowable. Basic is 80% of allowable.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Basic restorative is 80% of allowable.
[CUSTOMER][NEUTRAL] OK. Uh, major services are covered or not?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Thank you. So the endonic periodondex oral surgery uh is covered or not, please check.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Peron, what did you say? Endodontic and periodontic?
[CUSTOMER][NEUTRAL] Yeah, correct. And the only period is covered or not.
[AGENT][NEUTRAL] Period
[AGENT][NEUTRAL] Periodontic is under preventative.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And let me see about endedonic.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEGATIVE] Annoonic is not on the
[AGENT][NEUTRAL] Fax back fee schedule.
[AGENT][NEGATIVE] So therefore it's not covered.
[CUSTOMER][POSITIVE] Thank you so much. And uh for this policy, uh could you please help me to get the frequency for some services?
[AGENT][NEUTRAL] Um, if you give me your fax number, I will send you the fax back that has the complete, um, benefit and fee schedule for you.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh OK.
[CUSTOMER][POSITIVE] OK. Yeah, it's cool. Thank you so much. I'll provide the fax number 714.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I send that fax to you and I'll be right back.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you very much for holding for me, [PII]. I have that fax on its way to you now. You should be getting it at any time.
[CUSTOMER][NEUTRAL] Yes, sir.
[CUSTOMER][POSITIVE] Thank you so much. Sorry for that information. And, and sorry, could you please check, uh, the patient is the subscriber on this policy, right?
[AGENT][NEUTRAL] Yes, [PII] is the subscriber.
[CUSTOMER][POSITIVE] Thank you
[CUSTOMER][POSITIVE] Thank you so much. And finally, please verify me the claim's mailing address and the payer ID.
[AGENT][NEUTRAL] Yes, sir. The payer ID number is 60801.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the claim's mailing address is [PII].
[AGENT][NEUTRAL] And that's in [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][POSITIVE] Got it. Thank you so much. And uh which network we should use for this uh policy? Is it a Cardington?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Thank you so much, uh. And yeah, I'm done with this patient information. Please provide me the reference number for our call.
[AGENT][NEUTRAL] Yes sir, you can use my name [PII] and today's date.
[CUSTOMER][POSITIVE] Thank you, [PII]. Thank you so much for the assistance and help. Have a great day. Bye. Thank you.
[AGENT][POSITIVE] You too [PII] you have a wonderful day too, and thank you for calling APL.
[CUSTOMER][NEUTRAL] Bye bye.
[AGENT][NEUTRAL] Bye bye sir