AccountId: 011433970860
ContactId: 0bffbb48-2748-41b0-939e-1c7acd3b5d32
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 283880 ms
Total Talk Time (AGENT): 94427 ms
Total Talk Time (CUSTOMER): 106218 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=1.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/04/0bffbb48-2748-41b0-939e-1c7acd3b5d32_20250604T20:20_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling ATL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, [PII]. This is [PII] calling on behalf of the dental office to check eligibility and benefits for a member today on a recorded line. How are you doing?
[AGENT][POSITIVE] I'm good, thank you. I'm happy to check benefits. Can I get the policy number, [PII]?
[CUSTOMER][NEUTRAL] Mhm. Yeah, sure. I have your policy number as 02441228.
[CUSTOMER][NEUTRAL] And the patient's name is [PII].
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And date of birth?
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Data service.
[CUSTOMER][NEUTRAL] Then of.
[CUSTOMER][NEUTRAL] Data service, I'm sorry. I'm so sorry. I don't have that information.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do you have a build amount?
[CUSTOMER][NEUTRAL] Uh, um, no, I'm so sorry. That is not the information I'm looking and I don't have that information as well. I'm looking for the dental benefits.
[AGENT][NEUTRAL] You're just looking for the.
[AGENT][NEUTRAL] OK, so the patient's active. The effective date is [PII].
[CUSTOMER][NEUTRAL] [PII]. All right. And uh [PII], can you help me with the co-insurance and the annual max amount of the plan, please?
[AGENT][NEUTRAL] One moment, please.
[CUSTOMER][POSITIVE] Sure, take your time.
[AGENT][NEUTRAL] So the calendar year maximum is going to be 1500.
[AGENT][NEUTRAL] The calendar year deductible is going to be $50. Deductible does not apply to preventative services. Patients still have deductible and full calendar year amount remaining.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Patient's plan has preventative at 100% of UCR.
[AGENT][NEUTRAL] FMX and basic expenses are covered at 80% of UCR.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Major, which also includes endopperio and oral surgery, are covered at 40%.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Do we have any auto for this plan?
[AGENT][NEUTRAL] No ortho.
[CUSTOMER][POSITIVE] Mhm. All right. That is great then. Thank you so much for the information again. And so do we have any missing tooth cloths or waiting period under this policy?
[AGENT][NEUTRAL] This policy does have a missing tooth clause. There is a 12-month waiting period for all major expenses that does include again endoperio and oral surgery.
[CUSTOMER][NEUTRAL] Mhm. All right. That is great. What about the patient history for the preventative services? Is there any last date of service?
[AGENT][NEUTRAL] Last date of service on file is for [PII].
[AGENT][NEUTRAL] Patient had.
[AGENT][NEUTRAL] A cleaning exam.
[AGENT][NEUTRAL] And X-rays.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] Thank you so much for that information. And
[CUSTOMER][NEUTRAL] And there, that is all the history for, for this member?
[AGENT][POSITIVE] Mhm. Correct.
[CUSTOMER][POSITIVE] All right. Wonderful. Thank you so much, [PII], again for helping me with the information that I need. And with that, I am done with my questions. Before I let you go, can I have the call reference number of this call, please?
[AGENT][NEUTRAL] Call reference is going to be my name with today's date. My name again is [PII], that's [PII] Last initial is [PII], and then today's date.
[CUSTOMER][POSITIVE] Mhm. Wonderful. Thank you so much again for helping me. I hope that you have a great day ahead and take care. Bye-bye.
[AGENT][NEUTRAL] You too, [PII]. Bye-bye.
[CUSTOMER][NEUTRAL] Mhm. Bye-bye.