AccountId: 011433970860
ContactId: 07b98c50-be1b-483b-afd6-87da363c1e03
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 444029 ms
Total Talk Time (AGENT): 161140 ms
Total Talk Time (CUSTOMER): 139241 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/17/07b98c50-be1b-483b-afd6-87da363c1e03_20250217T19:51_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from Jefferson Rental. How are you doing today?
[AGENT][NEUTRAL] I'm fine, [PII]. How are you doing today?
[CUSTOMER][POSITIVE] Yeah, I'm doing great. Thanks for asking.
[AGENT][POSITIVE] Yeah, how can I help you?
[CUSTOMER][NEUTRAL] So, I'm calling to verify the eligibility and benefits for the patient. So could you please help me with that?
[AGENT][NEUTRAL] You're needing eligibility and benefits, [PII], is that correct?
[CUSTOMER][POSITIVE] Yeah, for dental benefits.
[AGENT][NEUTRAL] Yes. OK, so for our dental policies, [PII], uh, we have facts backs of all the dental benefits for the member's plan that I will send to you.
[AGENT][NEUTRAL] But first off, what is a good callback number for you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, the callback number is [PII].
[CUSTOMER][NEUTRAL] [PII]. It's a direct line.
[AGENT][NEUTRAL] OK, thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] Uh, the policy number is 02013730.
[AGENT][POSITIVE] OK, thank you, so give me a moment [PII] please to get the uh information pulled up.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] And [PII], any information that I do provide for you today will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yeah. Uh, the patient name is [PII] and the patient's date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. So I do show that he is the subscriber on this dental policy and it is active with an effective date of [PII].
[CUSTOMER][NEUTRAL] OK. 51 off. So he's a subscriber, right?
[AGENT][POSITIVE] He is the subscriber, that is correct.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Oh.
[AGENT][NEUTRAL] And what is your fax number, [PII]?
[CUSTOMER][NEUTRAL] Just a moment, please.
[CUSTOMER][NEUTRAL] So, I have only a few questions, like specific questions. Could you please help me verbally?
[AGENT][NEUTRAL] OK. What are your questions, [PII]?
[CUSTOMER][NEUTRAL] OK, thank you so much. Uh, so, uh, uh, I just told that, uh, the effective date is [PII], right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK. Could you please provide me the individual deductibles, family deductibles, and maximum?
[AGENT][NEUTRAL] Calendar, your maximum benefit is $1500 per covered insured.
[AGENT][NEUTRAL] The calendar year deductible is $50 per covered insured up to $150 per family.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. Is there any amount or amount from that?
[AGENT][NEUTRAL] For, for your patient?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] As of now for this calendar year, no sir there is not.
[CUSTOMER][NEUTRAL] OK, that nothing is, nothing is used and nothing is me, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. Could you please provide me the coinsurance percentages of preventative, basic, and major?
[AGENT][NEUTRAL] All of that information is on the fact that. Preventative is a 100% of UCR radiographs, basic and basic restorative or 80% of excuse me, UCR, major endoontic, periodontic and prosthodontic repair senses in oral surgery or 40% of UCR.
[CUSTOMER][NEUTRAL] OK. And uh uh what is the group number?
[AGENT][NEUTRAL] The group number is 17708.
[AGENT][NEUTRAL] [PII], are you still there?
[AGENT][NEUTRAL] Hello, [PII]. Are you still there?
[CUSTOMER][NEUTRAL] Yeah, yeah. Yeah, yeah. So the group number is 17708, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is there any other information that I can help you with?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh,
[CUSTOMER][NEUTRAL] What is the group name?
[AGENT][NEUTRAL] Universal Trucking Fort transfer.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, it, it is a current plan or physical airplane?
[AGENT][POSITIVE] This is I, yes, sir. I gave you the calendar year maximum benefit.
[CUSTOMER][NEUTRAL] OK. Uh, what are the coordination of benefits?
[AGENT][NEGATIVE] There is no coordination of benefits. This is not a network plan.
[CUSTOMER][NEUTRAL] Sorry, it is not an in-network plan.
[AGENT][NEUTRAL] Standard
[AGENT][NEGATIVE] No, it is not a network plan.
[CUSTOMER][NEUTRAL] So, I, OK, I need the network benefits, sir.
[AGENT][NEUTRAL] There is, this is not a network plan. There is no in-network or out of network benefits. It's based on the percentage of the.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Covered services are based on a percentage of the.
[AGENT][NEUTRAL] UCR of the service region.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Uh, what the beau.
[AGENT][NEUTRAL] This is what so
[AGENT][NEUTRAL] I'm sorry, what was your question?
[CUSTOMER][NEUTRAL] I'm
[CUSTOMER][NEUTRAL] Yeah, what is the pre-authorization required?
[AGENT][NEUTRAL] There's no priorization required.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there any waiting period on the plan?
[CUSTOMER][POSITIVE] Absolutely.
[AGENT][POSITIVE] Major endoperio prostate oral surgery or excuse me, all have a 12-month waiting period which has been satisfied.
[CUSTOMER][NEUTRAL] They
[CUSTOMER][NEUTRAL] So uh.
[CUSTOMER][NEUTRAL] OK. So there is a waiting period for 12 months, right?
[AGENT][NEUTRAL] On those 5 categories.
[CUSTOMER][NEUTRAL] OK, for what?
[AGENT][NEUTRAL] Major expenses, endodontic expenses, periodontic, prosthodontic repair expenses, and oral surgery.
[CUSTOMER][NEUTRAL] You look like
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] In TV or BW.
[CUSTOMER][NEUTRAL] I