AccountId: 011433970860
ContactId: e690211b-65ba-4e2e-918a-f1391f42d1e4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 367279 ms
Total Talk Time (AGENT): 104517 ms
Total Talk Time (CUSTOMER): 128424 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/2025/03/27/e690211b-65ba-4e2e-918a-f1391f42d1e4_20250327T14:30_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I'm calling from a dental office to verify insurance for a patient.
[AGENT][NEUTRAL] OK, [PII], so I can help you with eligibility and benefits. Do you have the patient ID?
[CUSTOMER][NEUTRAL] I do. It is let's see which one it is. OK, 025.
[CUSTOMER][NEUTRAL] 82,910.
[AGENT][NEUTRAL] And do you have a good callback number?
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] That is
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] The patient name is.
[CUSTOMER][NEUTRAL] [PII] and her date of birth in her [PII].
[CUSTOMER][NEUTRAL] I have [PII].
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, this is not a guarantee of payment, just a basic outline on the policy. Are you needing the benefits? I can send a fax back on that.
[CUSTOMER][NEUTRAL] Yes, so we can send a fax and if I can check if my is this a PPO policy?
[AGENT][NEUTRAL] Um, let me see, I.
[AGENT][NEUTRAL] Let me give you her effective date before I pull that up. Um, [PII], she's active.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And let's see, this is.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] No problem
[AGENT][NEUTRAL] Trying to see if they use the network or not hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, I don't see a network, uh, it is required on this.
[CUSTOMER][NEUTRAL] OK, so she can see a, a new dentist.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, does she have any really quick before the fax gets here, does she have any history of FMX panel or any exams?
[AGENT][NEUTRAL] Um, let me see.
[CUSTOMER][NEUTRAL] Or X-rays.
[AGENT][NEGATIVE] Don't have anything for [PII].
[AGENT][NEUTRAL] Yeah, I don't have any history at all on file for her.
[CUSTOMER][NEUTRAL] OK, and I believe just to call insurance just so I can know briefly what I'm gonna be looking at so I can.
[CUSTOMER][NEUTRAL] basics major or preventative or basic major.
[AGENT][NEUTRAL] Uh, so
[AGENT][NEUTRAL] So she has a $500 calendar year maximum, and it's not a guarantee of payment based outline of the policy. She does have coverage for preventative services, pays 100%.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And then basic services you're gonna pay 80%.
[AGENT][NEGATIVE] And then there's no major coverage on this policy.
[CUSTOMER][NEUTRAL] So is oral surgery covered?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] Or any extractions covered.
[AGENT][NEUTRAL] Be like an extraction? Do you have a
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Like a 07140.
[CUSTOMER][NEUTRAL] Um, I was
[CUSTOMER][NEUTRAL] Let's, yeah, 7,717,140 yeah.
[AGENT][NEUTRAL] Yes, that's covered under basic.
[CUSTOMER][NEUTRAL] So the 140.
[CUSTOMER][NEUTRAL] OK, and then how about a 7210?
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] What's the description on that?
[CUSTOMER][NEUTRAL] Um, I believe I need to 10 of the.
[CUSTOMER][NEUTRAL] Let me double check let me.
[CUSTOMER][NEUTRAL] The 7210 is which is that the extraction for.
[CUSTOMER][NEUTRAL] It's an extractionary, but is that a what kind of the description on the code I forgot it.
[CUSTOMER][NEUTRAL] Oh yeah, like the surgical extraction.
[AGENT][NEUTRAL] Yeah, it just has erupted so.
[CUSTOMER][NEUTRAL] OK, does that cover any ruptions?
[AGENT][NEUTRAL] Yeah, so 7140 is covered. I don't show 7210.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Now there's a deductible or any waiting periods.
[AGENT][NEUTRAL] Uh, the deductible is, get that back.
[AGENT][NEUTRAL] It's a $50 deductible. That's for basic, of course, not preventative.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, no waiting period.
[CUSTOMER][NEUTRAL] No waiting period. Alright, I'll just have to get that briefly because I'm about to send her back, but are you ready for my fax number?
[AGENT][POSITIVE] Yes, I'm ready.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] OK, I'll get that faxed. Um, just give me a moment and you should receive it.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Anything else I can help with, [PII]?
[CUSTOMER][NEUTRAL] Uh, I just wanna make sure this is not an HMO policy, correct?
[AGENT][NEUTRAL] No, it's not.
[CUSTOMER][POSITIVE] OK, thank you, no that's all I needed. You have a you have a nice day.
[AGENT][POSITIVE] Thanks for calling APL you too.
[CUSTOMER][NEUTRAL] Mhm bye.