AccountId: 011433970860
ContactId: e9ef3a6b-34d4-4b5a-b0be-808ae3b9c4f4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 339250 ms
Total Talk Time (AGENT): 94833 ms
Total Talk Time (CUSTOMER): 107390 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/10/e9ef3a6b-34d4-4b5a-b0be-808ae3b9c4f4_20250610T20:21_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I wanted to find out benefit information for a patient.
[AGENT][NEUTRAL] OK, [PII], I can help you with benefits. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] OK, thank you. And you have the policy number for that patient?
[CUSTOMER][NEUTRAL] Uh, yes, I do. The number that I have here is 620-414.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] [PII], date of birth is [PII].
[AGENT][NEUTRAL] Uh, I show the policy is active and effective [PII].
[AGENT][NEUTRAL] Um, for the benefits, I can send over a fax back that outlines all the dollar amounts that reimburse for each code.
[AGENT][NEUTRAL] Um, it also has the frequency, um, unless there's something you need to go over on the phone.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, so I'm not quite familiar with the facts, so uh let me just ask a couple questions that may or may not be on the facts. Could I have the group number?
[AGENT][NEUTRAL] number is
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Um, it's not a group, there's no group number, it's an individual policy.
[CUSTOMER][NEUTRAL] OK great and then um from the yearly maximum deductibles has anything been used or met?
[AGENT][NEUTRAL] Uh, they've met their deductible and
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEGATIVE] Oh, I'm sorry, they've not met their deductible. It's $50 not a guarantee of payment basic outline of the policy, and then the maximum is $1000 and that's also, um, nothing's been used.
[CUSTOMER][NEUTRAL] OK, so just to confirm you said the deductible has not been met.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, got it. Um, does this patient have any history on file for an FMX or panel and pro for your exam and bite wings?
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] Actually, I'm sorry, they have you $60 of the $1000. Sorry about that.
[AGENT][NEGATIVE] Deductibles still not in that.
[CUSTOMER][NEUTRAL] It's OK.
[AGENT][NEUTRAL] Um, yes, it appropriate.
[CUSTOMER][NEUTRAL] OK, got it.
[AGENT][NEUTRAL] Trophy was on.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] Um, the exam was on [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, bite wings, last bite wings were 2 1324, and
[AGENT][NEUTRAL] Um, it's been more than 5 years for the full mouth or panel.
[CUSTOMER][NEUTRAL] OK, so they'll be good to go for that one, but when was the date of service?
[AGENT][NEUTRAL] Uh, that was [PII] or [PII].
[CUSTOMER][NEUTRAL] OK, got it, um, and then for the code 4341, the SRPs can full quads be done on the same day?
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] It's once every 12 months per quadrant, so yes, they can all be done on the same day.
[CUSTOMER][NEUTRAL] Alrighty, um, does per maintenance 4910 share frequency with the pro fee?
[CUSTOMER][NEUTRAL] That
[AGENT][NEUTRAL] Uh, no, it doesn't.
[CUSTOMER][NEUTRAL] OK, um, all right, let's see, is there a missing tooth cloth?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK perfect and you said the this plan has a fee schedule and it doesn't go by percentages.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, no problem, um, OK, I'll get the rest of the information from the fax. Could I have the reference number for this call?
[AGENT][NEUTRAL] Reference number is my name, [PII] in today's date.
[AGENT][NEUTRAL] And then what is your effects?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][POSITIVE] OK, I'll get that faxed over. It just takes a few minutes. Anything else I can help with today?
[CUSTOMER][POSITIVE] No, that would be all thank you so much enjoy the rest of your day.
[AGENT][POSITIVE] OK, thank you for calling APLU as well. Bye-bye.