AccountId: 011433970860
ContactId: 01638036-154b-4643-9855-3e1caa751212
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 367000 ms
Total Talk Time (AGENT): 200610 ms
Total Talk Time (CUSTOMER): 71689 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/22/01638036-154b-4643-9855-3e1caa751212_20250122T14:19_UTC.wav
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[AGENT][POSITIVE] Thank you for contacting ATL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from Market Dental to verify patient eligibility and benefits and member ID starts with 9909.
[CUSTOMER][NEUTRAL] 27231.
[AGENT][POSITIVE] Yes, I can.
[AGENT][NEUTRAL] OK, thank you. I can help with eligibility and benefits. What is that policy number working up to today, uh, [PII]?
[CUSTOMER][NEUTRAL] Uh huh
[CUSTOMER][NEUTRAL] The callback number is [PII].
[AGENT][POSITIVE] I appreciate that. Thank you. Um, what is the policy number, please?
[CUSTOMER][NEUTRAL] The policy number was 990927231.
[AGENT][NEUTRAL] 723199092.
[CUSTOMER][NEUTRAL] 7231.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] 231. OK. It's uh let's see.
[AGENT][NEUTRAL] Is this, this isn't their social security number, is it?
[CUSTOMER][NEUTRAL] That's correct. This is only they have given.
[AGENT][NEUTRAL] I see. OK. Um, how do you spell the patient's last name, please?
[CUSTOMER][NEUTRAL] Patient's last name was it [PII].
[AGENT][NEUTRAL] OK, thank you. And their first name, please?
[CUSTOMER][NEUTRAL] First name [PII]
[AGENT][POSITIVE] I appreciate that. And [PII]'s birthday, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, let me see if I can't find it by his name.
[AGENT][NEUTRAL] OK, it looks like [PII]'s policy is uh
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Policy number is 006.
[AGENT][NEUTRAL] 14223 that went into effect on [PII]. It is active. Um, now, these policies, uh, this is a, a, um, uh, flat rate benefit policy. What it does is it will pay a flat rate for um certain services. Uh, there's $1000 per calendar year as the maximum, that's just a verification of the benefits, not a guarantee of payment.
[AGENT][NEUTRAL] Um, it doesn't look like for the calendar year [PII] that he's, uh, [PII] has used any of those benefits. You mentioned wanting to know about the benefits. Is there anything in particular, [PII], that I could tell you about them, or would you like a fax back?
[CUSTOMER][NEUTRAL] No, I do have some specific question. Is this policy is active from [PII]?
[AGENT][POSITIVE] That's correct, yes.
[CUSTOMER][NEUTRAL] It means there is no active dental coverage for this patient right now.
[AGENT][NEUTRAL] There's active dental, yes, right now, the, the policy is active.
[CUSTOMER][NEUTRAL] OK. Could you please help me what is the individual deductible, family deductible, and annual max for the patient?
[AGENT][NEUTRAL] The annual maximum is $1000 per calendar year. There's a $50 deductible that does not apply to preventative services, a $150 deductible for the family, and again, this is just a verification, not a guarantee of payment.
[CUSTOMER][NEUTRAL] And what are the coin insurance of preventive basic and major services?
[AGENT][NEUTRAL] There, there's no coordination of benefits and what the policy does is it pays a flat rate benefit, so there's not a percentage. Um, so for example, for the oral examinations, um, uh, we pay a flat rate benefit of $15 again, just a verification, not a guarantee of payment. For the adult cleaning, we pay a maximum of $40. Again, just a verification, not a guarantee of payment. So you see, it's not a, it's not a um a percentage. It's uh it's just a flat rate benefit.
[CUSTOMER][NEUTRAL] No, ma'am, what I'm asking is, what are the coincidences of preventive basic and measure?
[AGENT][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] Coinsurances.
[AGENT][NEUTRAL] The, the, well, that's the co-insurance, uh, the, uh, co-insurance is just, uh, there is no co-insurance for it. Um, it just, there isn't any coinsurance. It's just, it just pays that flight right benefit.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, could you please fax us the benefits?
[AGENT][NEUTRAL] Yes, I can do that. What is your fax number, please?
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII]. OK. And now is there anything else I can do before I send off this fax?
[CUSTOMER][NEUTRAL] Uh, the group number?
[AGENT][NEUTRAL] The group number for this policy that's
[AGENT][NEUTRAL] It looks like this is self pay so let me just check here.
[AGENT][NEUTRAL] OK. It looks like this, this policy is paid for by the, by the insured. So it's, it's not, there's not a group number or a group name.
[CUSTOMER][NEUTRAL] Uh huh, group name?
[AGENT][NEUTRAL] Um, it's not, there's not a group name. Um, it looks like they pay for the, the insurance themselves. And so there, it doesn't look like there's a group name or a group, uh, number.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, most of our policies are, are through their employer, but in this particular case, uh, this is just um uh they're paying for it themselves.
[CUSTOMER][NEUTRAL] OK, I think you have been faculty benefits.
[CUSTOMER][NEUTRAL] I'll be waiting for the wax.
[AGENT][NEUTRAL] OK, yes, I can, I can do that. Um, is there anything else I can do before, uh, while we're still on the phone?
[CUSTOMER][NEUTRAL] Nothing else I'm done with the patient. I need the fax, so that's all.
[AGENT][POSITIVE] OK, OK, I will go ahead and send that to you. Um, so you should be getting that in the next 10 minutes. If you have any questions, just let us know. Otherwise, uh, thank you for contacting APL. You have a very good.