AccountId: 011433970860
ContactId: f1b02dae-58ed-46bb-a95d-44e859880d8a
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 215639 ms
Total Talk Time (AGENT): 106439 ms
Total Talk Time (CUSTOMER): 67635 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/f1b02dae-58ed-46bb-a95d-44e859880d8a_20250401T21:14_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hey, I'm calling to get a patients um.
[CUSTOMER][NEUTRAL] Eligibility and benefits please.
[AGENT][NEUTRAL] OK, I'm happy to check on benefits and eligibility. What's the patient's policy number?
[CUSTOMER][NEUTRAL] I've got 646-761.
[AGENT][NEUTRAL] OK, let me pull that up here.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] And if you don't mind, can I get your first name and a callback number?
[CUSTOMER][NEUTRAL] Yeah my name is [PII] and the phone number is [PII].
[AGENT][NEUTRAL] Thank you. And then what's the patient's name and date of birth?
[CUSTOMER][NEUTRAL] It is [PII], date of birth [PII].
[AGENT][NEUTRAL] All right. And are we looking for medical or dental coverage?
[CUSTOMER][NEUTRAL] Dental.
[AGENT][NEUTRAL] So the patient's plan is active. This is a dental plan. The effective date on here is [PII].
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][POSITIVE] Perfect, OK.
[CUSTOMER][NEUTRAL] And can you tell me what her max and deductible is?
[AGENT][POSITIVE] Yeah, absolutely, let me pull that up here.
[AGENT][NEUTRAL] OK, so looks like her calendar year maximum on this plan is going to be $1000 and then the calendar year deductible is $50 and it's up to $150 per family.
[CUSTOMER][NEUTRAL] OK, do you show that she has met anything yet?
[AGENT][NEUTRAL] Yeah, let me see what.
[AGENT][NEUTRAL] Uh, no, looks like she has $50 deductible left and also the full calendar amount of $1000.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Now does she have um we are out of network so does she have out of network benefits um and does it pay the patient or the provider?
[AGENT][NEUTRAL] Uh, it just depends on who's filing the claim if you guys are filing, excuse me, the claim.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] It would be paid to you if she's doing it then we'll pay it on to her um this particular plan pays by um a fee schedule so if you needed it, we can send you a fax step back with a breakdown showing the amount.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][POSITIVE] That would be wonderful if you don't mind.
[AGENT][NEUTRAL] Yeah, no, not a problem whatsoever. What's a good fax number, [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] That's it.
[AGENT][NEUTRAL] Alright, I'm sending that now, so give it about 5 minutes and it should be over there, OK?
[CUSTOMER][NEUTRAL] OK, and that does show like what is covered as well, correct? like in the Donics?
[AGENT][NEUTRAL] Yes, yeah, so it's gonna show um a breakdown as far as um procedure codes. If it's not on the fax back, then it's not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Got it OK perfect well I will be looking out for that. Thank you so much.
[AGENT][POSITIVE] You are so welcome. You have a great rest of your day.
[CUSTOMER][POSITIVE] You too thank you.
[AGENT][NEUTRAL] Bye-bye.
[CUSTOMER][NEUTRAL] Bye bye.