AccountId: 011433970860
ContactId: e2bce7c7-bfc8-4519-9c2c-81d2973c4d5a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 318250 ms
Total Talk Time (AGENT): 119681 ms
Total Talk Time (CUSTOMER): 117056 ms
Interruptions: 1
Overall Sentiment: AGENT=1.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/20/e2bce7c7-bfc8-4519-9c2c-81d2973c4d5a_20250520T19:30_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL.
[AGENT][NEUTRAL] This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi I was calling to see if we were in network with this insurance. I had a patient calling to see if we took it, but I have not heard of this one.
[AGENT][NEUTRAL] OK, I can help you with the benefits and network for the patient. Um, can I please get your name and your callback number just in case the call is disconnected?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] [PII] and it's [PII].
[AGENT][NEUTRAL] OK, and then what's the name of the facility you're calling from, Ms. [PII]?
[CUSTOMER][NEUTRAL] Cypress Springs Family Dentistry.
[AGENT][NEUTRAL] OK. And then may I get the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Um, yes, the patient is [PII], and then the policy oh OK, sorry, 02363607.
[AGENT][NEUTRAL] OK, let me look her up real quick.
[AGENT][POSITIVE] Alright, I do show that [PII] does have an active policy with us. The effective date of her policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] is [PII].
[AGENT][NEUTRAL] And there isn't a network for this um policy it uh goes by, yes, it goes by the UCR of the policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] If you want to give me your um fax number I can send you a fax back with the benefit amount benefits and the schedule.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] That'd be great.
[CUSTOMER][NEUTRAL] OK, OK, so it goes off, so we file a UCR, but do y'all pay the UCR y'all pay off for your fee schedule and the difference between UCR and our the fee schedules what the patient owes? OK.
[AGENT][NEUTRAL] That please.
[AGENT][NEUTRAL] Yes, it's a percentage, it's a percentage of the UCR.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] OK, uh, fax number is [PII].
[AGENT][NEUTRAL] OK Miss [PII] I'm gonna put you on a brief hold while I get this fax ready for you and I will be right back.
[CUSTOMER][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you so much, Ms. [PII], for holding for me. I've got that fax on its way to you now.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, perfect. OK, so I'm just gonna clarify again so we still file UCR and then you're gonna, I guess you're gonna send a fee schedule and they patient no matter where they go would pay the difference between the office UCR and this fee schedule you're gonna send.
[AGENT][NEUTRAL] Right, it has the percentage on there for the UCR that the policy pays for the benefit.
[CUSTOMER][NEUTRAL] OK, so I'm not gonna get like a co-pay fee schedule. It's they pay the percentage of our UCR no matter where she goes.
[AGENT][POSITIVE] Right. Correct.
[CUSTOMER][NEUTRAL] OK, OK, OK, OK, I thought you meant you're gonna send like a fee schedule that y'all go off of, but it just goes off of UCR, OK, OK, got you.
[AGENT][NEUTRAL] And that
[AGENT][NEUTRAL] No, ma'am.
[AGENT][NEUTRAL] Yes, it goes off the UCR yes ma'am. And then when you get it, since this is the first time you've received one of our fax backs, if there's a procedure code that you're looking for that is not on the fax back then it's a non-covered procedure.
[CUSTOMER][POSITIVE] OK perfect
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh huh.
[CUSTOMER][NEUTRAL] Uh huh
[CUSTOMER][NEUTRAL] OK, so it's not on the fax back it's not covered, OK.
[AGENT][POSITIVE] Correct, yes ma'am, and I think everything else is on there that you'll need.
[CUSTOMER][NEUTRAL] OK, got you, OK.
[CUSTOMER][POSITIVE] OK perfect alrighty thank you so much for your help then.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] You're very welcome, Ms. [PII]. I hope you have a wonderful day and thank you for calling APL.
[CUSTOMER][NEUTRAL] You too.
[CUSTOMER][POSITIVE] Thank you alright thanks bye bye.
[AGENT][NEUTRAL] Bye bye.