AccountId: 011433970860
ContactId: 068e8654-28eb-4b25-82d0-10a8c59a1bae
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 476739 ms
Total Talk Time (AGENT): 180474 ms
Total Talk Time (CUSTOMER): 97880 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/26/068e8654-28eb-4b25-82d0-10a8c59a1bae_20250226T15:27_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII]. I'm calling from Reubin Dental. How are you doing today?
[AGENT][POSITIVE] I'm good [PII] how are you doing today?
[CUSTOMER][POSITIVE] Yes, I'm doing great. Can you please help me with the dental benefits and eligibility?
[AGENT][NEUTRAL] I sure can, [PII]. What is your callback number please?
[CUSTOMER][NEUTRAL] Yes, it is [PII].
[AGENT][NEUTRAL] What is the policy number please?
[CUSTOMER][NEUTRAL] It's a direct line. There's no extension.
[AGENT][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Uh, yes.
[CUSTOMER][NEUTRAL] The the ID is 2288041?
[AGENT][NEUTRAL] Yeah, that was 228-8041. Thank you. Verify the patient's name and date of birth.
[CUSTOMER][NEUTRAL] It is [PII]
[CUSTOMER][NEUTRAL] [PII] and the date of birth is [PII].
[AGENT][NEUTRAL] Thank you, and you're calling for eligibility and benefits, and this member shows effective as of [PII]. Policy shows active. And for benefits, please note verification of benefits provided does not guarantee payment. The member has a $1500 calendar year max for covered benefits.
[AGENT][NEUTRAL] With the $50 deductible.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The member here is a excuse me.
[AGENT][NEUTRAL] Preventative covers at 100% of UCR, basic services at 80%, and major services are covered at 40%.
[CUSTOMER][NEUTRAL] OK. Uh,
[CUSTOMER][NEUTRAL] Does this plan have uh only in network in in and out of network benefits?
[AGENT][NEUTRAL] This plan pays by UCR. There is no preferred provider network.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And what is the group name or group number?
[AGENT][NEUTRAL] OK, the group name is Universal Trucking.
[AGENT][NEUTRAL] And the group number is 15586.
[CUSTOMER][NEUTRAL] Just give me a second.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 15586.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, uh, can you please be online for a minute, [PII]?
[AGENT][NEUTRAL] OK, of course.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][POSITIVE] OK, thank you so much, [PII], and.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Uh, any amount used from the annual max?
[AGENT][NEUTRAL] OK, let me check that for you one moment.
[CUSTOMER][NEUTRAL] And the deductibles?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Nothing has been used for manual Max and me towards the deductible for [PII].
[CUSTOMER][NEUTRAL] OK. What is the orthole Max?
[AGENT][NEUTRAL] I'm sorry, you said Ortho Max?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] There is no or coverage on this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is there any history on this file that affects the frequency?
[AGENT][NEUTRAL] Let me check the history for you, one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do you remember I had bite wings on [PII]. That's one for 12 month period.
[AGENT][NEUTRAL] The member also had on [PII] a periodic oral exam and those are two for 12 month period.
[AGENT][NEUTRAL] I'm still searching for you one moment.
[AGENT][NEUTRAL] The last pro he was on [PII], and that's once every six months.
[AGENT][NEUTRAL] Let me check for FMX or PA for you one moment.
[AGENT][NEGATIVE] I show no history for FMX or PA and those are 1 per 5 year period again I show no history for those.
[CUSTOMER][NEUTRAL] OK. Uh, the, for exams and by wings, it is uh May, sorry, it is [PII], right?
[AGENT][NEUTRAL] Let me go back to that one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, [PII], that was a bite wings and a limited, excuse me, periodic oral exam. Again, that was [PII].
[CUSTOMER][NEUTRAL] OK. And is there any history for uh period maintenance and scaling SRP?
[AGENT][NEUTRAL] I'm sorry, payroll maintenance is, is that what you said? I'm so sorry.
[CUSTOMER][NEUTRAL] Uh, is there any history for period maintenance and SRP?
[AGENT][NEUTRAL] OK, maintenance thank you one moment.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] [PII] remember I had SRP.
[AGENT][NEUTRAL] Let's see here one moment.
[AGENT][NEUTRAL] 22nd.
[AGENT][NEUTRAL] I'm still searching one moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] On [PII], remember he had SRP that was upper right lower right and then on [PII] upper left and lower left were done.
[CUSTOMER][NEUTRAL] Uh, just give me a second, uh.
[CUSTOMER][NEUTRAL] Upper right and lower rate is on [PII].
[CUSTOMER][NEUTRAL] And uh [PII] is upper left and lower left, right?
[AGENT][POSITIVE] That is correct, yes.
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] OK, those are one for 24 months.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] Um, give me one second. I'm still searching for I do not show any history for pay maintenance, not show history for that.
[CUSTOMER][NEUTRAL] OK, that's all the history for uh.
[CUSTOMER][NEUTRAL] For preventative services.
[AGENT][NEUTRAL] Oh, SRP does not fall under the preventative services.
[CUSTOMER][NEUTRAL] Uh, rather than SRP, uh, there is no history for salines and fluoride.
[AGENT][NEUTRAL] No history for fluoride covered fluoride, uh, for sealants, um, that's actually an age limit for that that is under the age of [PII] for dependent children only.
[CUSTOMER][POSITIVE] OK, yes, that's all the information I need. Thank you so much, [PII] and for your time and patience. And can I get the call reference number for this call?
[AGENT][NEUTRAL] You're welcome. You're very welcome, [PII]. We do not provide call reference numbers. You can use my name and today's date. Last initial is [PII].
[CUSTOMER][POSITIVE] OK, thank you so much, [PII] and have a wonderful day. Bye bye.
[AGENT][POSITIVE] Thank you for calling APL. Take care. Bye bye.