AccountId: 011433970860
ContactId: 0fbcf021-b3ce-4014-ad6e-ee3524065952
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 384140 ms
Total Talk Time (AGENT): 110262 ms
Total Talk Time (CUSTOMER): 123412 ms
Interruptions: 0
Overall Sentiment: AGENT=1.7, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/07/0fbcf021-b3ce-4014-ad6e-ee3524065952_20250207T18:36_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]. My name is [PII] calling on behalf of provider's office to check up on eligibility and benefits on a recorded line. Could you please help me with that?
[AGENT][POSITIVE] I'm happy to check on benefits and eligibility today, [PII]. What's the patient's policy number?
[CUSTOMER][NEUTRAL] OK, it's starting with 4 consecutive zeros and then 249-7253.
[AGENT][NEUTRAL] Alright, let me pull that up one moment.
[AGENT][NEUTRAL] What is the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Patient's name is [PII].
[CUSTOMER][NEUTRAL] Uh, it's [PII] with the date of birth, [PII].
[AGENT][NEUTRAL] Thank you. And are you looking for medical or dental coverage?
[CUSTOMER][NEUTRAL] For dental coverage.
[AGENT][NEUTRAL] OK. Patient plan is active. The effective date on this is uh [PII].
[CUSTOMER][NEUTRAL] OK, and this would be a calendar year plan with the standard coordination of benefit, right?
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][POSITIVE] Thank you for that.
[CUSTOMER][NEUTRAL] OK, could you please help me with the plan maxim along with the used amount and the deductibles.
[AGENT][NEUTRAL] The calendar year maximum is $500 per covered insured.
[AGENT][NEUTRAL] The calendar year deductible is $50. That's going to be per covered insured up to $150 per family.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and the plan actually you said it's $500 like.
[AGENT][NEUTRAL] The patient
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, please continue. I'm sorry.
[AGENT][NEUTRAL] Patient, uh, patient has the full $500 left to use and the $50 deductible.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] OK, so [PII], do we have auto benefits in this policy?
[AGENT][NEGATIVE] No ortho coverage.
[CUSTOMER][NEUTRAL] OK. And as for the benefit breakdown, your diagnostic and preventative will be at 100%. Basic will be at 80% and make sure it's not covered, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, and endo endoperia and oral surgery, does it fall into the base, uh, major or basic?
[AGENT][NEUTRAL] Major.
[CUSTOMER][NEUTRAL] Major. That mean it's not covered, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, and do you have to maxim down your frequency?
[AGENT][NEUTRAL] Yes, they do once every 5 years.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And for exam and profits, OK, for exam, it's twice in 12 months and for profit, it's once every 6 months, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][POSITIVE] Thank you. And fluoride, is it covered?
[AGENT][NEUTRAL] Uh, let's see.
[AGENT][NEUTRAL] It is limited. Give me one moment.
[CUSTOMER][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] It is limited to dependent children under the age of [PII] and is maximum of 1 procedure per 12 months. It is covered.
[CUSTOMER][NEUTRAL] Bye bye.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] And seas, it's once every 36 months with the age limit of [PII], right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][POSITIVE] OK, and is not required to just suggested.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, so could you please check if there's any history that might affect the frequency?
[AGENT][POSITIVE] Yeah, absolutely. One moment.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] Last exam and bite wing X-rays were on [PII].
[CUSTOMER][NEUTRAL] A plan of [PII].
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that's the last date of service for Profo also for cleaning.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] It's a bit like OK.
[CUSTOMER][NEUTRAL] But the way through the company, yeah.
[CUSTOMER][NEUTRAL] Hello, [PII], can you hear me?
[AGENT][NEUTRAL] Uh, yeah. Was there anything else I can help you with? I'm sorry.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh no, no, it's OK. So you have a group name that is Oxford Global Resources LLC.
[CUSTOMER][NEUTRAL] Uh with the group number 70052, right?
[AGENT][POSITIVE] Uh yes, that is correct.
[CUSTOMER][NEUTRAL] OK, and does this policy also pay for the out of network?
[AGENT][NEUTRAL] Uh, no network is required for usage. It does participate in the Carrington PPO network.
[CUSTOMER][NEUTRAL] Thank you. OK, then, lastly, could you please help me with the call reference.
[AGENT][NEUTRAL] Call references my name with my last initial than today's date. My name is [PII], that's [PII]
[AGENT][NEUTRAL] My last initial is [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so, so I think there was a lot was needed here.
[CUSTOMER][POSITIVE] And yeah, once again, thank you very much for your help and assistance. You have a wonderful and a wonderful weekend bye bye. Thank you.
[AGENT][NEUTRAL] You too. Bye-bye