AccountId: 011433970860
ContactId: fbf88dd7-2557-4684-ab3b-112a8eadc7f6
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 254660 ms
Total Talk Time (AGENT): 140771 ms
Total Talk Time (CUSTOMER): 97887 ms
Interruptions: 1
Overall Sentiment: AGENT=1.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/fbf88dd7-2557-4684-ab3b-112a8eadc7f6_20250217T15:12_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Uh yes, my name is [PII] with Doctor [PII]'s office. I was just calling to get some information on my patient's benefits.
[AGENT][NEUTRAL] OK, [PII], do you also need eligibility or only benefit information?
[CUSTOMER][NEUTRAL] I guess both you could say.
[AGENT][NEUTRAL] OK. All right. I can help you with that. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] [PII] no extension.
[AGENT][NEUTRAL] Thank you and the member's policy number please, [PII].
[CUSTOMER][NEUTRAL] Policy start number is 02558147.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] What type of policy are you calling on [PII]?
[CUSTOMER][NEUTRAL] Um, it looks like it's a dental policy.
[AGENT][NEUTRAL] OK, so yes ma'am, I can help you with this now on our dental policies, [PII], we have fax facts of the members benefits that I'll be happy to send to you and anything not on the fax that means it would not be covered under the member's plan. So first off, again, any information that I do provide will be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] That's fine.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] It is [PII].
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] And I just wanted to verify with you that we are out of network with all insurances, so I just wanted to see if the patient had out of network benefits because I've honestly never heard of this.
[AGENT][NEUTRAL] OK, so this plan is not a network, yes, this is not a network plan benefits are based on covered services are based on a percentage of the UCR of the service region. So again this is not a network plan.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So I do show that she is the spouse of the insured on this policy, and it is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that information will also be on your fax back. What's a good fax number that I can send this to, [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK thank you just one moment and does it need to be put to your attention or is that not necessary?
[CUSTOMER][NEUTRAL] No, it's OK. I'll be looking for it. My next question for you is that this looks like this is a secondary policy for her. She does have primary.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] My next thing about it is is that it looks like.
[CUSTOMER][NEUTRAL] She does have a waiting period for basic and restorative information. Can you just verify that for me?
[AGENT][NEUTRAL] She would on for basic, basic restorative, there's no waiting period on this policy.
[CUSTOMER][NEGATIVE] There is not OK, because it's saying on the benefits that they got that there's a 12 month waiting period.
[AGENT][NEUTRAL] For major endoimperio and prosthodontic and oral surgery, yes. And that is on page one of the facts back that I'm going to send you.
[CUSTOMER][NEUTRAL] Major Indo and [PII].
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Perfect. And just to clarify, claims address is [PII]?
[AGENT][NEUTRAL] That is correct, and that will also be on your fax fax it's by your ID and fax.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Yeah, is the
[CUSTOMER][POSITIVE] Perfect thank you so much I appreciate it.
[AGENT][NEUTRAL] Oh, you're certainly welcome. So I have just sent that to you now just uh one more thing, [PII] once we've processed the claim here at APL, we do have a portal in which you should be able to check claim status and have access to our EOB by going to secured. [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And is there anything else I can help you with this morning?
[CUSTOMER][POSITIVE] OK, sounds good.
[CUSTOMER][NEUTRAL] No ma'am.
[AGENT][POSITIVE] OK, well then, thank you so much for calling APO [PII] and I hope you have a great day.
[CUSTOMER][POSITIVE] All right perfect thank you so much.
[AGENT][POSITIVE] You're welcome. Bye bye.
[CUSTOMER][NEUTRAL] Bye bye.