AccountId: 011433970860
ContactId: fe69473c-327a-45d2-901b-8055b67c6d85
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 478339 ms
Total Talk Time (AGENT): 220318 ms
Total Talk Time (CUSTOMER): 140849 ms
Interruptions: 0
Overall Sentiment: AGENT=0.2, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/13/fe69473c-327a-45d2-901b-8055b67c6d85_20250213T14:21_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I was calling to.
[CUSTOMER][NEUTRAL] Sorry.
[CUSTOMER][NEUTRAL] Oh, I was calling to verify a patient's benefits.
[AGENT][NEUTRAL] Your name?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what's the policy number, [PII]?
[CUSTOMER][NEUTRAL] Um let's see.
[CUSTOMER][NEUTRAL] This one's gonna be 00712942.
[AGENT][NEUTRAL] Are you a medical or dental provider?
[CUSTOMER][NEUTRAL] dental provider?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And what is a good phone number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, and do you want the schedule of benefits faxed over to you?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Uh, yes, if that would, that would be great.
[AGENT][NEUTRAL] OK, and what's your
[CUSTOMER][NEUTRAL] Would it have all the information on there?
[AGENT][POSITIVE] It it does. I'll give you a breakdown of what's gonna be on there.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And um the fax is [PII]?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, let me pull up the policy number and verify the patient, and then we'll get that over to you.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Her name is gonna be [PII] Uh date of birth is [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So I'm showing an effective date of [PII].
[AGENT][NEUTRAL] I show that the policy is active at this time.
[AGENT][NEUTRAL] Um, on the schedule of benefits, it'll include, um.
[AGENT][NEUTRAL] The effective date, um, the coverage type, um, the calendar year maximum and deductible information, the frequencies, common limitations, exclusions, uh, the claims mailing address, payer ID number, and fax number, and then it lists each procedure code that's covered under this policy, gives a description of that code, and then it provides a benefit.
[AGENT][NEUTRAL] Uh, under this plan it's not $180.40 it's a specific dollar amount that's payable for each procedure, uh huh, and it, it could possibly be about 6 pages including the cover sheet.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you should receive it within the next 5 to 7 minutes.
[CUSTOMER][NEUTRAL] OK, and um, are we under a specific fee schedule or no?
[AGENT][NEUTRAL] Uh, the network of contracted providers is Carrington. Are you familiar with Carrington?
[CUSTOMER][NEUTRAL] Yes, I am Carrington.
[AGENT][NEUTRAL] OK, that's a PPO network of contracted providers. We do not have a list of their contracted providers, so I can't verify that, but I can give you the phone number if you would like, unless you already know.
[AGENT][NEUTRAL] Whether you are.
[CUSTOMER][NEUTRAL] No, it's fine. Um, just what's the timely filing?
[AGENT][NEGATIVE] No timely filing limit.
[CUSTOMER][NEGATIVE] And no coordination of benefit either?
[AGENT][NEUTRAL] It's standard.
[CUSTOMER][NEUTRAL] Stander.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And what have the downgrades on there or no downgrades?
[AGENT][NEUTRAL] There are no downgrades and it's listed on here under the patients. It's no downgrades.
[CUSTOMER][POSITIVE] No downgrades.
[CUSTOMER][NEUTRAL] Do y'all pay on prep day or seat day?
[AGENT][NEUTRAL] Either or
[CUSTOMER][NEUTRAL] Will it have the 5750 code, the reline frequency?
[AGENT][NEUTRAL] You know that's major. If it's covered, it'll be listed on here. If it's not on here, that means it's not covered.
[CUSTOMER][NEUTRAL] OK, if it's not on there, it's not covered. Alrighty.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Cover.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] What was your first name?
[AGENT][NEUTRAL] You'll use my name in today's state as your reference, [PII] A, first initial of my last name is [PII] and the schedule is on its way. And [PII], did you have any other questions?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] They all, does it have like the waiting period of missing tooth cloths on there too?
[AGENT][NEUTRAL] Um, there are no waiting periods under this policy, and the missing tooth clause is listed under limitations.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, perfect. And yeah, that, that's all.
[AGENT][POSITIVE] OK, and so I just, you're welcome. I just sent the schedule over to you so you should receive it shortly.
[CUSTOMER][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] Also, does it have the, the patient's history or does it won't apply that?
[AGENT][NEUTRAL] Yeah, the history is not included. Give me a moment and I'll take a look at that.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, so the last service I'm showing.
[AGENT][NEUTRAL] For preventive services is [PII]. It looks like uh she had the D0140.
[AGENT][NEUTRAL] On that day
[AGENT][NEUTRAL] Um, looks like she received an Olozal guard on the [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, [PII], she had some fillings.
[CUSTOMER][NEUTRAL] When was the Coastal guard? Sorry.
[AGENT][NEUTRAL] Um, [PII].
[AGENT][NEGATIVE] And actually we didn't pay anything on that one.
[CUSTOMER][NEGATIVE] Oh, y'all didn't pay on it.
[AGENT][NEUTRAL] Let's see, let's see. Oh, the calendar year maximum was exhausted.
[AGENT][NEUTRAL] At that time, uh.
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And no FMX on file?
[AGENT][NEUTRAL] Uh, what's the code for that?
[CUSTOMER][NEUTRAL] The [PII] to 10.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] So she had a full mouth X-ray, D0210 on [PII], and a comprehensive orally valve D0150 on the same date.
[AGENT][NEUTRAL] And I think she had one of, I think she had a cleaning. Give me a second.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] She also had a cleaning on [PII].
[CUSTOMER][POSITIVE] OK, perfect.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right. I guess I have it all.
[AGENT][NEUTRAL] All right, so.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Um, like I said, the schedule is on its way, and did you have any other questions, [PII]?
[CUSTOMER][NEUTRAL] Mm, oh, I guess she hasn't been with us in a while, so.
[CUSTOMER][NEUTRAL] OK, and the max and deductible, does it have it on there?
[AGENT][NEUTRAL] It's on the schedule.
[CUSTOMER][POSITIVE] OK, perfect then. That would work.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] All right, I guess that's all for me. Thank you.
[AGENT][POSITIVE] Oh, you're wel you're welcome, [PII]. Thanks for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] You too bye bye.