AccountId: 011433970860
ContactId: 0e9eda36-09f0-4765-a580-7eeb4037a060
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 606080 ms
Total Talk Time (AGENT): 219217 ms
Total Talk Time (CUSTOMER): 126468 ms
Interruptions: 0
Overall Sentiment: AGENT=0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/16/0e9eda36-09f0-4765-a580-7eeb4037a060_20250116T19:26_UTC.wav
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[CUSTOMER][NEUTRAL] Hello.
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hello, this is [PII], and I need dental benefits of a member.
[AGENT][NEUTRAL] OK, and what was your name again?
[CUSTOMER][NEUTRAL] He's
[AGENT][NEGATIVE] OK, we have a really bad connection. I'm having a hard time hearing you. Did you say your name is [PII]?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII], OK, thank you, ma'am.
[AGENT][NEUTRAL] And you're looking for dental benefits. Miss [PII], what is your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK. How do you, what is the patient's name?
[CUSTOMER][NEUTRAL] Patient name is [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK, and then what's [PII]'s policy number?
[CUSTOMER][NEUTRAL] 02093617
[AGENT][NEUTRAL] OK, let me pull up that policy.
[AGENT][NEUTRAL] OK, I do show that [PII] does have an active policy and his effective date is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I'll need to get your fax number so that I can send you a fax back with this complete benefit breakdown.
[CUSTOMER][NEGATIVE] No, actually I called 2 times before also. One, I called 2 hours before and then I called like half an hour before and asked for fax, but I didn't receive any fax, so I need it verbally only.
[AGENT][NEUTRAL] OK, hold on, let me see what fax number I have.
[AGENT][NEUTRAL] Is your fax number [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] OK, I can send that right to you.
[AGENT][POSITIVE] I'm gonna stay on the phone with you.
[CUSTOMER][NEUTRAL] No, actually,
[CUSTOMER][NEGATIVE] But actually it's very urgent and 2 times also I called before but didn't receive any fax. So I, I have some CDT codes and I want to ask about some benefits only, not I don't have too much of it.
[AGENT][NEUTRAL] OK. All right, let.
[CUSTOMER][NEUTRAL] So can you please help me properly?
[AGENT][NEUTRAL] OK, let me look it up real quick.
[AGENT][NEUTRAL] OK, what is your first question?
[CUSTOMER][NEUTRAL] What is the group name and number?
[AGENT][NEUTRAL] OK, and this is just to verify benefits it's not a guarantee of payment and you're wanting to know I'm sorry, our connection is really bad. What was that that you were asking again?
[CUSTOMER][NEUTRAL] Group name and group number.
[AGENT][POSITIVE] Yes, I can give that to you.
[AGENT][NEUTRAL] The group name is Universal Trucking.
[AGENT][NEUTRAL] Langer Transport.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] The, the group number?
[AGENT][NEUTRAL] It's 24913.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And can you please take down the deductible and the accumulated amount?
[AGENT][NEUTRAL] OK look and see what they had if they've used anything for the year.
[AGENT][NEUTRAL] OK, the deductible has been paid.
[CUSTOMER][NEUTRAL] Uh, what's the deductible amount?
[AGENT][NEUTRAL] And he
[AGENT][NEUTRAL] The deductible was $50 but it has already been paid for the year of 20, 0 wait, wait, wait, wait, let me check.
[AGENT][NEUTRAL] In 2025.
[AGENT][NEUTRAL] OK, he still has his $50 deductible left to pay this year for 2025 and he still has $1500 left for the maximum for the year.
[CUSTOMER][NEUTRAL] OK. What's the co-pay percentage for preventive basic and major?
[AGENT][NEUTRAL] Uh, the basic is.
[AGENT][NEUTRAL] 80% of UCR.
[AGENT][NEUTRAL] Major is 40% of UCR.
[CUSTOMER][NEUTRAL] 80% preventive and basic.
[AGENT][NEUTRAL] Preventive is 100% of UCR.
[CUSTOMER][NEUTRAL] OK. And basic is 180.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] And major is 40.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, so I have some CDT codes. Should I give it one by one or all at once?
[AGENT][NEUTRAL] One by one
[CUSTOMER][NEUTRAL] 0120.
[AGENT][NEUTRAL] 0120 periodontic oral evaluation.
[AGENT][NEUTRAL] And let me see, there's a limitation on it, let me look.
[AGENT][NEUTRAL] Limited to two oral evaluation procedures that any combination of 001200014000150.
[AGENT][NEUTRAL] 0016000180 per 12 month period.
[CUSTOMER][NEUTRAL] 0272
[AGENT][NEUTRAL] OK, let me look.
[AGENT][NEUTRAL] OK, bye wing limited to one bite wing X-ray procedure 002700027200274 per 12 month period.
[CUSTOMER][NEUTRAL] 0210
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, I'm looking. What is the, um, what kind of procedure is it? Is it preventative? Is it basic?
[CUSTOMER][NEUTRAL] Fullm
[CUSTOMER][NEUTRAL] Yeah, full mouth X-ray preventative.
[AGENT][NEUTRAL] Preventative.
[AGENT][NEUTRAL] OK, let me look.
[AGENT][NEGATIVE] It is not.
[AGENT][NEGATIVE] On the fee schedule, right, so it's not covered.
[CUSTOMER][NEUTRAL] Not
[CUSTOMER][NEUTRAL] 0330
[AGENT][NEUTRAL] OK, and what kind of procedure is this?
[CUSTOMER][NEUTRAL] Preventative
[AGENT][NEUTRAL] Preventative.
[CUSTOMER][NEUTRAL] Sometimes basic, but most of the time representative.
[AGENT][NEUTRAL] OK, let me look on both.
[AGENT][NEUTRAL] That's not on the fee schedule.
[CUSTOMER][NEUTRAL] OK, and fluoride 1206?
[AGENT][NEUTRAL] Fluoride would not be covered because he's over the age.
[CUSTOMER][NEUTRAL] OK. And seas?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, BG and E.
[AGENT][NEUTRAL] Let me see on that one for you.
[AGENT][NEUTRAL] Yes, that's not covered because he's over age.
[CUSTOMER][POSITIVE] OK. Thank you so much. What's the call reference number?
[AGENT][NEUTRAL] You can use my name, it's [PII].
[AGENT][NEUTRAL] And today's date.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] You're very welcome, Miss [PII]. I hope you have a great day and thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Bye-bye, ma'am.