AccountId: 011433970860
ContactId: 0eca7472-b416-48aa-b841-5d03a10bba4d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 241529 ms
Total Talk Time (AGENT): 116668 ms
Total Talk Time (CUSTOMER): 67722 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/24/0eca7472-b416-48aa-b841-5d03a10bba4d_20250424T18:13_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] I'm sorry, what was your name again?
[AGENT][NEUTRAL] My name is [PII].
[CUSTOMER][NEUTRAL] Hi, so my name is [PII] and I'm calling to check eligibility on a patient please.
[AGENT][NEUTRAL] Sure, I can assist you with eligibility, Mr. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] Unknown caller.
[AGENT][NEUTRAL] Thank you and may I have the name of the facility that you're calling from?
[CUSTOMER][NEUTRAL] And dental planner, Dr. [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you and may I have the patient's policy number?
[CUSTOMER][NEUTRAL] I have 02576121.
[AGENT][NEUTRAL] Thank you. One moment, let me pull that policy.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] It's [PII]. Date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And you say you need eligibility for dental. We have an effective date of [PII]. It is active at the moment and this is one of our basic dental policies.
[CUSTOMER][NEUTRAL] I it.
[CUSTOMER][NEUTRAL] Is this a PPO plan?
[AGENT][NEUTRAL] It's a commercial plan.
[CUSTOMER][NEUTRAL] What does that mean?
[AGENT][NEUTRAL] It means it doesn't have any networks.
[CUSTOMER][NEUTRAL] OK, but it is covered for out of network then?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK and then can you tell me um.
[CUSTOMER][NEUTRAL] What, what's the co-insurance for preventative, uh, basic and major?
[AGENT][NEUTRAL] OK. Let me go ahead and give you benefits and this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer. And bear with me, let me just go ahead and pull the benefits.
[CUSTOMER][NEUTRAL] Alright
[AGENT][NEUTRAL] OK, so for this one we have a calendar year maximum of 500.
[AGENT][NEGATIVE] With a $50 deductible and deductible does not apply to preventative.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Preventative is cover 100%.
[AGENT][NEUTRAL] Radiograph FMX is covered at 80%.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Basic expense and basic restorative expenses cover 80%.
[AGENT][NEUTRAL] And there's no major service?
[AGENT][NEUTRAL] So endodontics, periodontics, prosthoonic repair or surgery crowns and bridges are not covered under this policy.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then is this based out of um the payment is it based out of the UCR fee, the user customary fee, or is it a fee schedule plan?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] No, it's a UCR.
[CUSTOMER][NEUTRAL] Pres scheduled?
[AGENT][NEUTRAL] Yes, you see.
[CUSTOMER][NEUTRAL] Oh, UCR.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then what's your mailing address?
[AGENT][NEUTRAL] Mailing address is [PII]. Zip code is [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And the payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] OK, OK, that I think that should be it and you said it is based out of the usual and customary fees, right?
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][POSITIVE] OK, OK, thank you so.
[AGENT][POSITIVE] You're welcome and thank you for calling APL. Have a good afternoon, [PII].
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thank you, bye bye.