AccountId: 011433970860
ContactId: f33e340b-eeb9-4ae4-904e-cdf2c2b2990b
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 385299 ms
Total Talk Time (AGENT): 176230 ms
Total Talk Time (CUSTOMER): 144993 ms
Interruptions: 4
Overall Sentiment: AGENT=0.1, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/12/f33e340b-eeb9-4ae4-904e-cdf2c2b2990b_20250512T15:32_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. You and I actually spoke last week in regards to some benefits for a patient for a dental policy, and I got the fax back. I just have some additional questions.
[AGENT][NEUTRAL] OK Miss [PII], I can help you with your questions. um, may I please get your call back number ma'am just in case the call's dropped.
[CUSTOMER][NEUTRAL] Yes, so that's [PII].
[AGENT][NEUTRAL] OK, and what was the name of the provider's office you're calling from?
[CUSTOMER][NEUTRAL] Uh, this would be oral Surgery Associates, Doctor [PII].
[AGENT][NEUTRAL] OK, and then what was the um patient's name, date of birth and policy number?
[CUSTOMER][NEUTRAL] [PII] 41491 policy number is 02346809.
[AGENT][NEUTRAL] Oh, I remember this one.
[AGENT][NEGATIVE] I couldn't get the um fax back to go through until after the office closed and I was like, oh no, she's not gonna have it today. I do remember this. I tried like 4 times to send it to you.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] No, that's OK.
[AGENT][POSITIVE] I'm glad you got it though, OK, and.
[CUSTOMER][POSITIVE] Well, I appreciate you. Yes, I did.
[AGENT][NEUTRAL] It kept coming back, um, uh, like it was rejected and I was like, OK, I'm gonna keep on trying because I remember you saying that was the first time you'd used this or knew about this insurance and I was like,
[AGENT][NEUTRAL] I sure don't wanna have mess up on the first time she's tried to use us.
[CUSTOMER][POSITIVE] No, that's OK. No, I I definitely received it, so no problem.
[AGENT][NEUTRAL] OK, and what are the questions you had for him? Sure.
[CUSTOMER][NEUTRAL] Now I do have some general questions in regards to the bin.
[CUSTOMER][NEUTRAL] Perfect, so what is the group number for his policy?
[AGENT][NEUTRAL] Yeah, go ahead.
[AGENT][NEUTRAL] The group number is 19205.
[CUSTOMER][NEUTRAL] OK, and is this an individual policy or through an employer?
[AGENT][NEUTRAL] It's through an employer and I can give you that name.
[CUSTOMER][POSITIVE] Perfect yeah if you can when you're ready.
[AGENT][NEUTRAL] It's Universal truck.
[AGENT][NEUTRAL] Yes, it's Universal Trucking, P as in Paul, and S as in Sam, transportation.
[CUSTOMER][NEUTRAL] OK, are there any waiting periods that need to be satisfied?
[AGENT][NEUTRAL] Uh, let me look and see, um, the effective date of the policy was [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, let me pull up.
[CUSTOMER][NEUTRAL] So I'm assuming any waiting period is probably satisfied if there was one.
[AGENT][POSITIVE] Right, right. Cause it, it is 12 months and it's been, yeah, 2 years. That's good.
[AGENT][NEUTRAL] Did you have any other questions that I might be able to help you with?
[CUSTOMER][NEUTRAL] Oh yes, I'm so sorry yes I'm so sorry, um, so out of his $1500 maximum has anything been used today?
[AGENT][NEUTRAL] No, that's OK. It's OK.
[AGENT][NEUTRAL] Let me check that for you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] No, nothing's been used and the deductible is still left to pay.
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] And this is just to verify his benefits. It's not a guarantee of payment.
[CUSTOMER][NEUTRAL] Understood. um, can you tell me, does medical need to be billed first for inactions or does it stay with dental?
[AGENT][NEUTRAL] Is the impactions um code on the fax back that you received?
[CUSTOMER][NEUTRAL] Uh, yes, so they are listed as a covered benefit.
[AGENT][NEUTRAL] OK. So on this policy, medical is not covered, it would have to go to the medical insurance.
[CUSTOMER][NEUTRAL] OK, but meaning in order for this dental policy to process it, a medical EOB is not necessary for impacted teeth, is that correct?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] We can go straight to the dental, OK, perfect, um, and then can you tell me if the patient has any history of a 0140 or panel or FMX?
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Let me check that for you because he only has one claim he's ever had with us, so let me check and see what that code is.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] It be just a second.
[AGENT][NEUTRAL] Actually, it's a claim that was just sent in on [PII] and it hasn't been processed yet.
[CUSTOMER][POSITIVE] Sure, take your time.
[AGENT][NEUTRAL] Um
[AGENT][NEGATIVE] And I can't pull it up because it hasn't even been signed a claim number yet.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] No, that's OK right now I'm gonna leave it then that the patient is eligible. We're actually not gonna now see him for probably about a month, so that'll give us time to re-verify the benefits uh early next month before we see him.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, yes, yes, ma'am, and it usually takes um if you wanted to call back sooner than 1 month, it usually takes 7 to 10 business days to process the claim, so this should be, should be have a number here pretty soon.
[CUSTOMER][POSITIVE] OK OK perfect that sounds.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK perfect and again I would just use your name in today's date as the as the reference number correct?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] OK all right perfect that's everything I needed thank you so much.
[AGENT][POSITIVE] You're welcome Miss [PII] you have a good week thank you for calling APL.
[CUSTOMER][NEUTRAL] You too bye bye.