AccountId: 011433970860
ContactId: e052a840-cb28-4ecf-b2bb-8dfaa6550f78
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 165960 ms
Total Talk Time (AGENT): 103768 ms
Total Talk Time (CUSTOMER): 60460 ms
Interruptions: 0
Overall Sentiment: AGENT=1.8, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/27/e052a840-cb28-4ecf-b2bb-8dfaa6550f78_20250127T16:35_UTC.wav
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[AGENT][NEUTRAL] Contacting ATL, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hey this is [PII]. I'm calling from a provider's office and I just need to see about getting a breakdown of benefits, seeing if we are in network and then also seeing what the schedule we need to follow.
[AGENT][NEUTRAL] Yes, I can help with that. And uh [PII], what's the policy number that we're looking at today?
[CUSTOMER][NEUTRAL] Um, it looks like it's 02579754.
[AGENT][NEUTRAL] Thank you, and the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Um, we will do there's several dependents, um, but [PII], date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And is there a callback number I can have in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] Thank you very much. The policy went into effect on [PII]. It is active. Um, this policy has $1500 for calendar years and maximum.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's just a verification of the benefits, not a guarantee of payment.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] There is no, uh, there is no network, and so what we do is we use a percentage of the UCR. I do have a form that I can send to you. It tells you everything that is covered, um, but, uh, basically preventative services are at 100% of UCR, um, basic and basic restorative are at 80% of UCR, and, uh, the major coverages.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, such as endodontics, periodontal services, and oral surgery, are at 40% of UCR, um, but they have a 12-month waiting period, which, um, you know the the thing that started, um.
[CUSTOMER][NEUTRAL] But
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] Now there is no network, uh, as I mentioned before, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything in particular that I can uh tell you about or would you like me to send you a fax?
[CUSTOMER][NEUTRAL] like
[CUSTOMER][NEUTRAL] Um, yeah, if you could just send me a fax, um, and then I'll take a look at it and I'll just give you a call back if I have any questions.
[AGENT][POSITIVE] Yes, I can help with that. What is your fax number, please?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][POSITIVE] Great. OK, I will go ahead and uh send this to you. Um, now, once you do receive it, uh, you know, if you do have any questions, any one of us will be able to assist you. Uh, I don't have any history for this, uh, individual, so, um, as I mentioned before, we're just starting a [PII]. Uh, if there's nothing else at all that I can help with, um, then thank you very much for contacting ATL. You should be getting your facts in the next few minutes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] OK great thank you so much.
[AGENT][POSITIVE] OK, have a good morning. Thanks for contacting A.