AccountId: 011433970860
ContactId: e617e0c7-5d9e-45d0-9153-eb586a9ccfec
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 611049 ms
Total Talk Time (AGENT): 207245 ms
Total Talk Time (CUSTOMER): 224091 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/26/e617e0c7-5d9e-45d0-9153-eb586a9ccfec_20250326T15:09_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][POSITIVE] Hi, good morning. My name is [PII]. How are you today?
[AGENT][POSITIVE] I'm good. How are you?
[CUSTOMER][POSITIVE] I'm doing fine. Thank you. Thank you for asking.
[AGENT][POSITIVE] Yes, sir. How can I help you?
[CUSTOMER][NEUTRAL] And maybe maybe I'm, I'm calling regarding a patient eligibility and questions about the maximum, uh, the breakdown of the benefits, uh, of that stuff, uh, can you help me with that please?
[AGENT][POSITIVE] Yes, sir. I can assist you with benefits. First, can I get your name and a good callback number?
[CUSTOMER][NEUTRAL] My name is [PII] and the callback number is [PII].
[CUSTOMER][NEUTRAL] [PII] again [PII].
[AGENT][NEUTRAL] Thank you, [PII]. Now I need the policy number, please.
[CUSTOMER][NEUTRAL] Yes, policy number is 02465237.
[AGENT][NEUTRAL] And please verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] [PII] is the first name, [PII]'s last name, date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you and just let me advise you that verification of coverage does not guarantee payment of claims. Um, I'm showing the effective date on this policy was.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] Um, [PII] and the policy is still active.
[AGENT][NEUTRAL] Um, I'm showing that the calendar year benefit maximum is 1500 and again, that's per calendar year.
[AGENT][NEUTRAL] But there is a $50 deductible that needs to be met first.
[AGENT][NEUTRAL] And let's see, has he met the deductible yet?
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Um, so far he has not met the deductible or used any of the $1500.
[AGENT][NEUTRAL] To his benefit maximum.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. OK. And what is the group name and group number?
[AGENT][NEUTRAL] OK, the group
[AGENT][NEUTRAL] The group name is Universal Trucking.
[AGENT][NEUTRAL] Stevens Transportation.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the group number is 17626.
[CUSTOMER][NEUTRAL] 6 OK and we are in network with the patient plan.
[AGENT][NEUTRAL] Um, we work with our providers. There is no network. Um, there is a Carrington network available, but it's not required.
[CUSTOMER][NEUTRAL] Carrington, OK, uh, and the Carrington, it's the fee schedule we can follow.
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK, great. And the, the, the plan have missing two class or waiting period.
[AGENT][NEUTRAL] OK, let's see.
[AGENT][NEGATIVE] There is a missing tooth cloth.
[CUSTOMER][NEUTRAL] And waiting period.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, for which procedures there are waiting periods.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] So, uh, in a, in, uh, no, no in particular procedure or they have any waiting period for May or something like that.
[AGENT][NEUTRAL] Yes
[AGENT][NEUTRAL] Yes, there's a twelve-month waiting period.
[CUSTOMER][NEUTRAL] 12 months. Uh, for what procedure for major?
[AGENT][NEUTRAL] Yes, for major, for endodontic.
[AGENT][NEUTRAL] Periodontic.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Prosdontic and oral surgery.
[CUSTOMER][NEUTRAL] Uh, um
[CUSTOMER][POSITIVE] This waiting period it's already satisfied or satisfied on [PII].
[CUSTOMER][NEUTRAL] This year.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Yes, I'm showing that the waiting period have been satisfied.
[CUSTOMER][POSITIVE] has been on April was satisfied, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And a couple of days.
[CUSTOMER][POSITIVE] Great, great. And uh what is your payer ID?
[AGENT][NEUTRAL] The pay ID is 60801.
[CUSTOMER][NEUTRAL] Oh sorry, can you repeat that? 60801.
[AGENT][NEUTRAL] Um, 60801.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And what is the best address to send the claim?
[AGENT][NEUTRAL] And that mailing address is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that's in [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] Great. This plan have auto benefits?
[AGENT][NEUTRAL] Ortho, one moment. No, orthodontic is not covered.
[CUSTOMER][NEGATIVE] Just not OK.
[CUSTOMER][NEUTRAL] And they have implant coverage.
[AGENT][NEUTRAL] What type of coverage?
[CUSTOMER][NEUTRAL] Uh, implants like 6010 or 6056 is the code.
[AGENT][NEGATIVE] No. Implants are not covered.
[CUSTOMER][NEUTRAL] OK. OK. OK. OK. And um
[CUSTOMER][NEUTRAL] Oh sorry, and from the maximum uh don't have used anything yet from the 1500.
[AGENT][NEGATIVE] Right nothing
[AGENT][NEUTRAL] Right. Nothing's been used so far this year.
[CUSTOMER][NEUTRAL] And they have history that affects the eligibility.
[AGENT][NEUTRAL] No, I'm not showing any.
[CUSTOMER][NEUTRAL] OK, 3 and they have downgrades for fillings or crowns.
[AGENT][POSITIVE] No, there are no downgrades.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the crowns are paid on rep date or C date.
[AGENT][NEUTRAL] Either one.
[CUSTOMER][NEUTRAL] Either or, right? That doesn't matter.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And they uh
[CUSTOMER][NEUTRAL] Core buildup can be made on the thing there as the ground.
[AGENT][NEUTRAL] What's the question?
[CUSTOMER][NEUTRAL] Oh, if the court buildup and crown can be made on the same day.
[AGENT][POSITIVE] Yes, sir, they can.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And the extraction codes they need to send to medical first or straight to dental.
[AGENT][NEUTRAL] Straight to dental.
[CUSTOMER][NEUTRAL] And the SNP is for 2 quads per visit or all 4 quarts on the same.
[AGENT][NEUTRAL] It doesn't matter either or.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, and the pre finance they share frequency with prophy or other codes.
[AGENT][NEUTRAL] What's your question again, please?
[CUSTOMER][NEUTRAL] Oh, is the carrier maintenance code 49.
[CUSTOMER][NEUTRAL] They share frequency with the profit.
[CUSTOMER][NEUTRAL] 11th
[AGENT][NEUTRAL] OK, one moment. No, I'm showing that they don't.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And for a breakdown of the benefits, I can fax that to you. Is there someone I can, somewhere I can fax this to?
[CUSTOMER][NEUTRAL] And they, if you
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] Oh, well, yes, I appreciate it. Uh, can you provide me the, the facts for the benefits?
[AGENT][NEUTRAL] Oh, it's [PII]. That's to submit the claim, but in order for me to um fax you the breakdown of the benefits, I will need your fax number.
[CUSTOMER][NEUTRAL] Oh yes. The fax, it's uh [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, so that's attention, Arturo [PII].
[CUSTOMER][NEUTRAL] Mhm. Right.
[AGENT][POSITIVE] OK. You should receive this fax in about 10 minutes. Is there anything else that I can assist you with? This is a breakdown of all the benefits that answer all your questions.
[CUSTOMER][NEUTRAL] Oh, and if don't uh find the code on the fax, I suppose it is not covered.
[AGENT][NEUTRAL] Right, if it's not on the facts, it's not covered. That's correct.
[CUSTOMER][POSITIVE] Great. And the
[CUSTOMER][NEUTRAL] The exams, regular exam and problem focus, uh, they share frequency or each separate benefits?
[AGENT][NEUTRAL] It's separate for benefits.
[CUSTOMER][NEUTRAL] and treatment and exam can be done on the same day.
[AGENT][POSITIVE] Yes, I can.
[CUSTOMER][POSITIVE] OK, great. And for very last, uh, can you help me with the reference number of the call and thank you so much for that.
[AGENT][NEUTRAL] Yes, the reference number is my name and today's date. My name is [PII]. It's spelled [PII] Last initial is [PII] like [PII] and today's date. Is there anything else that I can assist you with?
[CUSTOMER][POSITIVE] Um, no, that's all. And well thank you so much for that and I appreciate your time and your help and uh have a wonderful day.
[AGENT][NEUTRAL] You do the same, Mao. Thank you for calling ATL. Mm bye.
[CUSTOMER][POSITIVE] You have a great day.
[CUSTOMER][POSITIVE] Thank you. Bye.