AccountId: 011433970860
ContactId: f527d2f2-cb14-440b-a998-786e500bb254
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 230059 ms
Total Talk Time (AGENT): 103299 ms
Total Talk Time (CUSTOMER): 123784 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/f527d2f2-cb14-440b-a998-786e500bb254_20250304T16:30_UTC.wav
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[AGENT][NEUTRAL] For contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi there, my name is [PII]. I'm calling from Plaza Dental in [PII]. Just calling regarding um verification of eligibility benefits um for a patient of ours.
[AGENT][NEUTRAL] I can help with the eligibility and benefits, sir. What is that policy number we're looking at today?
[CUSTOMER][NEUTRAL] OK, it is 02113904.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Yeah, [PII] and it's [PII].
[AGENT][NEUTRAL] Thank you. I just need a callback number please in the event that we're disconnected.
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][POSITIVE] I appreciate that. Thank you. The policy, um, let's see if I can get it here.
[AGENT][NEUTRAL] The policy went into effect on [PII]. It is active. Now these have $1500 per calendar year as the maximum. That's just a verification of those benefits and I guarantee a payment, um, and what it does is it, uh, picks up the deductible.
[CUSTOMER][NEUTRAL] Mhm, mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Excuse me, I'm sorry, it picks up the, um, percentage of the UCR for um services such as preventative, basic, basic, restorative, major services. It doesn't look like [PII]'s ever used this policy, so it does look like that's all available. I have a fax that I can send to you, or is there anything in particular that I can tell you about the policy?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh, OK, you could send a fax, but can I ask you a couple of questions? Um, uh, what's the payer ID if it's not listed on the fax? I guess if it is, that's great.
[AGENT][POSITIVE] Yes, of course.
[AGENT][NEUTRAL] It's
[AGENT][NEUTRAL] Um, 60801.
[CUSTOMER][NEUTRAL] 60801 thank you and then do they um will you pay the provider's office or reimburse the patient?
[AGENT][NEUTRAL] Uh, whoever turns in the claim.
[CUSTOMER][NEUTRAL] When we said like, so if it's us, yeah, OK, got you, we'll submit it, um, electronically so I just wanted to make sure that it, uh, check will be cut to our provider's office. Sometimes insurances are not that way, so and then um.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Oh yes.
[CUSTOMER][NEUTRAL] Uh, is there a missing tooth cloth?
[AGENT][NEUTRAL] There he is.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then any ortho coverage?
[AGENT][NEUTRAL] Uh, no, no, there is not.
[CUSTOMER][NEUTRAL] OK, and then is there any downgrades on posterior composites or posterior crowns?
[AGENT][NEUTRAL] No, no, there is not.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then is there a payment on a prep date or seat date for a crown?
[AGENT][NEUTRAL] Either of those two dates.
[CUSTOMER][NEUTRAL] Oh OK, just whenever we submit, is that correct?
[AGENT][POSITIVE] Absolutely, that's, that's true. Whenever you submit it, that's when we'll do it.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, alright, alright, I think that should work if I have other questions after I look at the facts I'll call back, but yeah, I can give you our fax or however that works.
[AGENT][NEUTRAL] Yes, um, sir, what is that fax number, please?
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] OK, I'm gonna go ahead and send this to you now and um once you get this, if you have any questions, uh please just let us know, but um if there's nothing else that I can help with, uh, or is there anything else that I can help with, I should say.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, I don't think so. Um, I guess like I said there's a few extra, um.
[CUSTOMER][NEUTRAL] Is the fax, you know, does it have quite a few things covered procedure codes or is it real minimal like just exams and cleanings and.
[AGENT][NEUTRAL] Uh, no. What it does is it, it tells you what is covered and what percentage of UCR we cover it at. Um, so it, it goes into, and now, if you don't, if there's a code that you don't see, um, please let us know. Uh, usually there's something that's comparable, uh, but, um, yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 00 yeah I understand. OK, that'll work just fine no problem no I shouldn't need anything else. I'll just wait for the fax.
[AGENT][POSITIVE] OK, I just sent that to you. Um, thank you very much for contacting us. You have a very good morning.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.