AccountId: 011433970860
ContactId: e0734541-4fa7-4f86-8969-eef7c8b95224
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 441880 ms
Total Talk Time (AGENT): 175787 ms
Total Talk Time (CUSTOMER): 162937 ms
Interruptions: 1
Overall Sentiment: AGENT=0.8, CUSTOMER=1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/e0734541-4fa7-4f86-8969-eef7c8b95224_20250304T18:20_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey [PII], I'm calling from a dental office. I have a patient here, um, she just provided her insurance to me. I'm just trying to get a verification of her benefits, please.
[AGENT][NEUTRAL] Sure, let's take a look at those benefits for you. uh, what was your name?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK, thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, it is 614-966.
[AGENT][NEUTRAL] OK and uh what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Um, it is [PII] and her date of birth is, sorry, [PII].
[AGENT][NEUTRAL] OK, thank you so much for verifying that information, [PII]. Uh, so this policy is active. Effective date was [PII], and if you'd like, I can send you a fax back that shows all of the covered procedures and benefit information.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Do you mind just telling me over the phone um since she's here that would be great thank you so much um we are also out of network so could you give me that um coverage for out of network?
[AGENT][POSITIVE] Oh sure, yeah, of course.
[AGENT][POSITIVE] Definitely
[AGENT][NEUTRAL] So
[AGENT][NEUTRAL] This policy does, um, it strictly pays off of, um, like a set dollar amount per covered procedure. It does not have a set network.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK perfect um what is her max and deductible?
[AGENT][NEUTRAL] Of course, and of course I will let you know verification of coverage is not a guarantee of payment for claims. So the calendar year maximum is $1000. There is a $50 deductible per calendar year that does not apply to uh preventative or exams.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then what is preventative, basic, and major covered out?
[AGENT][NEUTRAL] So again these aren't going to be percentages um they're going to be particular or specific dollar amounts per procedure code.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, can I give you a procedure code and you can tell me, OK, um, it's for a crown D2740.
[AGENT][NEUTRAL] Of course.
[AGENT][POSITIVE] Absolutely.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] 2740, that benefit amount is $357.
[CUSTOMER][NEUTRAL] OK, I have another question. She does have primary insurance, so if they pay 50% and we file to you, is it still you guys pay $357 or will that change? You still will pay that.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes, yes, there's no coordination of benefits, right.
[CUSTOMER][NEUTRAL] OK, that's great. OK, what about, um, let me put in sorry this code for a build up um because that's what we're doing today um that code is D2950.
[AGENT][NEUTRAL] That's OK.
[AGENT][NEUTRAL] 2950. That benefit amount is $79.
[CUSTOMER][NEUTRAL] 79. OK and then um do y'all keep on file any history? I know she's had.
[AGENT][NEUTRAL] Uh, yeah, I can see if she's got any history. Let's take a look.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, um, let's see.
[AGENT][NEUTRAL] Were there particular codes you needed to look to see if she's had?
[CUSTOMER][NEUTRAL] Um, I need to check on crowns specifically maybe 11 through 15.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, 11 through 15 and I can give you that code again D2740.
[AGENT][NEUTRAL] Was that
[AGENT][NEUTRAL] Got it. OK.
[AGENT][NEUTRAL] All right, bear with me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] And I'm so sorry. Tell me again, which, uh, which teeth?
[CUSTOMER][NEUTRAL] 11 through 15.
[AGENT][NEUTRAL] 15, OK. I see one for 2:30.
[AGENT][NEUTRAL] Bear with me just a moment. This is a bit of an older policy. It does go back quite a ways.
[CUSTOMER][POSITIVE] No, you're fine. I appreciate you checking.
[AGENT][NEUTRAL] Of course.
[CUSTOMER][POSITIVE] I'm good.
[AGENT][NEUTRAL] OK, I do see 1 2744211.
[CUSTOMER][NEUTRAL] OK, and then what date was that on?
[AGENT][NEUTRAL] That was [PII].
[CUSTOMER][NEUTRAL] OK, I guess that pretty far.
[CUSTOMER][NEUTRAL] Uh, what is y'all frequency on crowns?
[CUSTOMER][NEUTRAL] You'll have a frequency?
[AGENT][NEUTRAL] Oh let me see. I don't know that this one specifies, but give me just a moment to see.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] No, I'm not seeing that it shows uh uh frequency.
[CUSTOMER][NEUTRAL] OK, that's perfect and then what is your payer ID?
[AGENT][NEUTRAL] It is 60801.
[CUSTOMER][NEUTRAL] OK, and then can you give me a good address for y'all also?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Of course, um, that is [PII].
[AGENT][NEUTRAL] 950.
[AGENT][NEUTRAL] And that is in [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][POSITIVE] OK, I think you've answered all my questions so I appreciate it so much.
[AGENT][NEUTRAL] Of course did you still want me to go ahead and send you this fax back just so you'll have it for your records?
[CUSTOMER][POSITIVE] Yes, that would be great. Um, let me give you our fax number it is [PII].
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, I'm gonna read that back to make sure I heard that correctly. That was [PII]?
[CUSTOMER][POSITIVE] That is correct.
[AGENT][NEUTRAL] Alrighty I will get this sent to you um in short, if you're looking for a specific procedure and you don't see it listed under the fax pack that simply means it's not going to be a covered procedure.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] OK, that's good to know thank you so much I appreciate it.
[AGENT][POSITIVE] Alright, you are very welcome. Thanks for giving us a call. I hope you have a great rest of your day.
[CUSTOMER][NEUTRAL] Alright.
[CUSTOMER][POSITIVE] OK, have a good day.
[AGENT][POSITIVE] Thank you. Bye bye.