AccountId: 011433970860
ContactId: 065e9011-7d47-4501-8762-6461b2d1279d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 590979 ms
Total Talk Time (AGENT): 179550 ms
Total Talk Time (CUSTOMER): 175956 ms
Interruptions: 2
Overall Sentiment: AGENT=0.2, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/24/065e9011-7d47-4501-8762-6461b2d1279d_20250224T20:40_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII] how may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I was calling in order to have a dental benefit breakdown for a patient.
[AGENT][NEUTRAL] OK Miss [PII], I can um send you a fax back um can I get your callback number just in case our call is connected?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Thank you and then what's the patient's name, date, and policy number?
[CUSTOMER][NEUTRAL] Oh, I'm sorry, can you repeat that?
[AGENT][NEUTRAL] Yes, ma'am, what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] So, patient's name is [PII]. That's spelled [PII]
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then policy number is 02560658.
[AGENT][NEUTRAL] Thank you. And what is uh the patient's date of birth?
[CUSTOMER][NEUTRAL] Patient's date of birth is [PII].
[AGENT][NEUTRAL] Thank you. And can you please give me the name of the facility you're calling from, Ms. [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, so the name is Family Dental care.
[CUSTOMER][NEUTRAL] I gave it to.
[AGENT][NEUTRAL] OK, let me look up that policy real quick.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Mhm and then actually before you do, can you let me know if my provider is in network or out of network?
[AGENT][NEUTRAL] Yes ma'am.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, I do show that uh.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] See, Jamie, Jamie has an active policy. The effective date is [PII]. They can use any dental provider that they choose to use. We base our fee schedule on UCR, usual customary reasonable.
[CUSTOMER][NEUTRAL] B
[CUSTOMER][NEUTRAL] I know I got it.
[CUSTOMER][NEUTRAL] Oh, give me one second. Let me, oh hello?
[AGENT][NEUTRAL] And if you give me your fax number I'll.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, so let me write that down. Um, I'm sorry, it's because you're kind of cutting off here and there, but you said that the fee schedule that we that you use is what?
[AGENT][NEUTRAL] I can hear you.
[AGENT][NEGATIVE] Oh, no.
[AGENT][NEUTRAL] So
[CUSTOMER][NEUTRAL] To relocate
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, I said it's UCR.
[CUSTOMER][NEUTRAL] UCR.
[CUSTOMER][NEUTRAL] OK, and.
[AGENT][NEUTRAL] Mm. And if I can get your fax number I can send you a fax back with complete benefit breakdowns for NC schedule.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, so it's gonna be [PII].
[AGENT][NEUTRAL] Thank you. Um, let me read it back, make sure I've got it correct, Miss [PII]. [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] That's correct.
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I pull up this fax back for you, and I'll be right back.
[CUSTOMER][NEUTRAL] Mhm. OK. You are on hold.
[AGENT][NEUTRAL] UTBA there you are.
[AGENT][NEUTRAL] Come on.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Come on.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 347
[CUSTOMER][NEUTRAL] OK, and you.
[AGENT][POSITIVE] Thank you for holding for me Miss [PII] I've got that fax on its way to you now.
[CUSTOMER][NEUTRAL] Mhm. Oh, OK, perfect. Um, actually, before I let you go, can I ask you a few questions?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] OK, so what's your PO box?
[AGENT][NEUTRAL] For to mail claims to is [PII].
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that's in [PII] City, [PII], and the zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK and then is this a calendar year?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, and then is there any waiting period?
[AGENT][NEUTRAL] Uh, that is also on the fax back for you, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] For major expenses and this is just to verify benefits, it's not a guarantee of payment for major expenses, there's a 12 month waiting period.
[AGENT][NEUTRAL] Endedonic is 12 months, Perontic is 12 months, prosthodontic is 12 months, and oral surgery is 12 months.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, alrighty, let's see um.
[CUSTOMER][NEUTRAL] Is there a missing tooth cloth?
[AGENT][NEUTRAL] Yes ma'am.
[CUSTOMER][NEUTRAL] Yes, missing too, OK. And then is there a replacement rule for like bridges, centers, and crowns?
[AGENT][NEUTRAL] Uh, that is also on the fax back and it goes by procedure code. So if the procedure code is not on the fax back, then it's a non-covered procedure.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm. Got it. OK, is the maximum benefit also on the fax pack?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK. Um, does she still have a full, um, maximum benefit?
[AGENT][NEUTRAL] Let me check for you real quick.
[CUSTOMER][POSITIVE] Thank you we'll send you a reminder as we get closer, OK?
[AGENT][POSITIVE] No problem at all.
[CUSTOMER][POSITIVE] Thank you have a great day thank you.
[AGENT][NEUTRAL] Yes, she still has her $50 deductible left to pay and she still has her $1500 max.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] OK, and then real quick, can I just have a reference number please?
[AGENT][NEUTRAL] Yes ma'am, you can use my name [PII] and today's date.
[CUSTOMER][POSITIVE] Got it. OK, so [PII], and then today's date. Perfect. Thank you so much for your help, [PII].
[AGENT][POSITIVE] You're very welcome, Miss [PII]. You have a blessed day and thanks for calling APL.
[CUSTOMER][NEUTRAL] Is it OK
[CUSTOMER][POSITIVE] Thank you bye bye.
[AGENT][NEUTRAL] Bye bye.