AccountId: 011433970860
ContactId: 0532bf79-9401-4773-9244-bc5eedc7b0dc
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 392570 ms
Total Talk Time (AGENT): 186573 ms
Total Talk Time (CUSTOMER): 103855 ms
Interruptions: 1
Overall Sentiment: AGENT=1.2, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/30/0532bf79-9401-4773-9244-bc5eedc7b0dc_20250430T17:47_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, I just wanted to see if my patient had any dental benefits.
[AGENT][NEUTRAL] OK, so you're needing to check dental eligibility and benefits. Is that correct?
[CUSTOMER][NEUTRAL] Uh, yes.
[AGENT][POSITIVE] Yes, ma'am, I can help you with that. And we
[AGENT][NEUTRAL] We do have facts facts of the benefits on our dental policies, but I'll be happy to send to you once I can get the member's information pulled up.
[CUSTOMER][POSITIVE] Perfect, thank you.
[AGENT][NEUTRAL] You're welcome. And who am I speaking with, please?
[CUSTOMER][NEUTRAL] Uh, my name was [PII].
[AGENT][NEUTRAL] Thank you. And [PII], what is your callback number?
[CUSTOMER][NEUTRAL] It is gonna be [PII].
[AGENT][NEUTRAL] Thank you. And what is the member's policy number, please, [PII]?
[CUSTOMER][NEUTRAL] It is 02506653.
[AGENT][POSITIVE] Thank you, uh, give me a couple of moments please to get the member's information pulled up.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEUTRAL] OK, and any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name please, [PII], and their date of birth?
[CUSTOMER][NEUTRAL] It is [PII] and date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] So I do show that he is the subscriber on this plan and this dental policy is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] Alright, is this a dental PPO plan?
[AGENT][NEGATIVE] It is not.
[AGENT][NEUTRAL] There is no network with this plan. The the covered expenses are based on a percentage of the UCR of the service region.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that is stated as well on the fax back.
[CUSTOMER][NEUTRAL] OK, so would he, so is he still able to see us if there's no network?
[AGENT][NEUTRAL] He can choose any provider. There is no this is not a network plan, so he may select any provider to go to.
[CUSTOMER][NEUTRAL] Is he just out of network?
[CUSTOMER][NEUTRAL] Um, OK, and would it be, so it would be UCR fees?
[AGENT][NEUTRAL] Again, yes, ma'am, the covered services are based on a percentage of the UCR of the service region.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, and would I be able to check a couple codes with you?
[AGENT][NEUTRAL] As far as
[AGENT][NEUTRAL] If they're covered under his policy.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Yes ma'am just a moment and all the codes are.
[AGENT][NEUTRAL] They're also on the fax back and anything not listed as far as the code would not be covered, [PII], and it does give you their limitations and all of that information as well. What's the codes you would like checked?
[AGENT][NEUTRAL] To see if it's covered.
[CUSTOMER][NEUTRAL] Um, can I
[CUSTOMER][NEUTRAL] Um, can I check 7921?
[AGENT][NEUTRAL] 792 1.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Is that correct?
[AGENT][NEUTRAL] That's not covered?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And would I be able to check um 9223?
[AGENT][NEUTRAL] Also not covered?
[CUSTOMER][NEUTRAL] OK, perfect. um, does it have his uh maximum deductible on the backpack?
[AGENT][POSITIVE] Yes, ma'am, it does.
[CUSTOMER][NEUTRAL] OK, um, then yeah, that should be all I needed then if I could just do the fax.
[AGENT][POSITIVE] Absolutely. OK. So, what is a good fax number for you?
[CUSTOMER][NEUTRAL] So it'll be [PII].
[AGENT][NEUTRAL] Oops. Alright, I'm sorry. Give me just, I got a little ahead of myself. Just one moment.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] No, no worries.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, and what is the um fax number?
[CUSTOMER][NEUTRAL] Um, if I could do [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, and I'm just gonna repeat that back to you. It is going to be [PII]. Is that correct?
[CUSTOMER][NEUTRAL] Uh yes.
[AGENT][NEUTRAL] OK, so that has been fine so provided that there's not any issues with it being received or sent, you should be receiving that very soon. And if you all do end up filing a claim with us for him, [PII], once we have processed the claim, we do have a portal in which you should be able to check the claim status in and that website for the portal is located at [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK perfect um and would I just be able to get a reference number for the call?
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Yes, ma'am, you would use my name that I gave you along with today's date.
[CUSTOMER][NEUTRAL] OK, and what was the name? I'm sorry?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK, perfect, that should be all that I needed thank you so much.
[AGENT][POSITIVE] OK, [PII]. Well, if there's nothing else that I can help you with today, thank you for calling APL and I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] Thanks so much you too.
[AGENT][POSITIVE] Yes, ma'am. You're very welcome. Bye bye.