AccountId: 011433970860
ContactId: 114e371f-180a-4e51-9c9b-01bd1389e206
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 438480 ms
Total Talk Time (AGENT): 200088 ms
Total Talk Time (CUSTOMER): 127898 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/10/114e371f-180a-4e51-9c9b-01bd1389e206_20250410T16:51_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII] calling from Jefferson Dental.
[CUSTOMER][NEUTRAL] How are you doing today?
[AGENT][NEUTRAL] I'm fine, [PII]. How are you doing today?
[CUSTOMER][POSITIVE] I'm doing good, thank you for asking and I'm calling.
[AGENT][POSITIVE] Good. How can I help you?
[CUSTOMER][NEUTRAL] I'm calling to verify the eligibility and benefits for your patient. Could you please help me with that?
[AGENT][NEUTRAL] OK, [PII], you're needing to get eligibility and benefit information for a dental policy, is that correct?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][POSITIVE] Yes, I can help you with that, [PII]. And what is a good callback number for you?
[CUSTOMER][NEGATIVE] My callback number is [PII] and there is no extension.
[AGENT][NEUTRAL] Thank you. And the member's policy number, please?
[CUSTOMER][NEUTRAL] Uh, the policy number is 02013730.
[AGENT][POSITIVE] Thank you one moment.
[AGENT][NEUTRAL] OK, and same on our fax facts, we, I'm sorry, on our dental policies, we have fax facts of the member's benefits, so I'll be happy to send you that and it will have all of the benefit information on the fax back. Anything not on the fax back means it would.
[CUSTOMER][NEUTRAL] In
[AGENT][NEUTRAL] Ma'am.
[CUSTOMER][NEUTRAL] In verbal.
[CUSTOMER][NEUTRAL] In verbal, ma'am?
[AGENT][NEUTRAL] I'm sorry, I'm not understanding you.
[CUSTOMER][NEUTRAL] Could you please provide me the benefits in verbal?
[AGENT][NEUTRAL] I can do that and any information provided will be a verification of benefits and not a guarantee of payment. What is your patient's name and date of birth?
[CUSTOMER][NEUTRAL] The patient name is [PII] and the date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] So he is a subscriber on this general policy. It is active with an effective date of [PII].
[AGENT][NEUTRAL] And what type of the [PII] is the effective date.
[CUSTOMER][NEUTRAL] It's [PII]
[CUSTOMER][NEUTRAL] What was the effective date?
[CUSTOMER][NEUTRAL] It's [PII]. Am I right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, so patient policy is active, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. I need dental in-network benefits, ma'am. Could you
[AGENT][NEUTRAL] I'm sorry. Let me, let me give, give me just a moment. On the effective date, that should be [PII].
[CUSTOMER][NEUTRAL] It's [PII].
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK. So it is the policy is active, right?
[AGENT][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] OK. Ma'am, I need dental in-network benefits. Could you please provide me the deductibles for this patient?
[AGENT][NEGATIVE] This is not enough.
[AGENT][NEUTRAL] Yes, ma'am. The the deductible is $50 per covered insured.
[AGENT][NEUTRAL] The calendar year.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the calendar, your maximum benefits 150.
[CUSTOMER][NEUTRAL] What was the family deductible?
[CUSTOMER][NEUTRAL] OK. What was the, what was the annual max?
[AGENT][NEUTRAL] 1500 per covered insured.
[CUSTOMER][NEUTRAL] Could you please confirm the individual deductible would be 50, family deductible would be 150, and annual max is 1500, right? Could you please provide me the coinsurance percentages of preventative basic and major services?
[AGENT][POSITIVE] Correct.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] OK, this is a non-network plan. Benefits are based on a percentage of the UCR of the service region. Preventative it's covered at 100% of UCR, radiographs, FMX, basic, and basic restorative are 80% of UCR subject to the $50 calendar year deductible. Major endedontic periodontic, prosthodontic, and oral surgery are covered at 40% of the UCR.
[AGENT][NEUTRAL] Also subject to the $50 calendar year deductible.
[CUSTOMER][NEUTRAL] OK, what was the group number?
[AGENT][NEUTRAL] 17708.
[CUSTOMER][NEUTRAL] What was the group name?
[AGENT][NEUTRAL] Universal Trucking Fort Transfer.
[CUSTOMER][NEUTRAL] What was the payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] Uh, ma'am, these are all dental in-network benefits, right?
[AGENT][NEGATIVE] Again, this is not a network plan. There is no network for this policy.
[CUSTOMER][NEUTRAL] But, but ma'am, I need in-network benefits.
[AGENT][NEUTRAL] Yes, ma'am, but I can't give you in-work benefits when it's not a network plan.
[CUSTOMER][NEUTRAL] OK. You, but uh you provided me the in-network benefits, but the plan was not in-network, right?
[AGENT][NEUTRAL] No, sir, uh, no, ma'am. No, ma'am. I provided you with the benefits based on the UCR of the service region.
[CUSTOMER][NEUTRAL] Ma'am, actually, I need in-network benefits, ma'am.
[AGENT][NEGATIVE] I don't know how else to explain this to you, [PII]. There is no in-work benefits because this is not a network plan.
[CUSTOMER][NEUTRAL] Just wait a moment, ma'am. Let me check.
[CUSTOMER][POSITIVE] Thank you for being, thank you for.
[CUSTOMER][NEUTRAL] Hi, thank you for being on hold.
[AGENT][NEUTRAL] Yes, ma'am
[AGENT][POSITIVE] Uh, yes, ma'am. And how can I, can I help you today?
[CUSTOMER][NEUTRAL] Uh, ma'am, I need in-network benefits, ma'am, dental in-network.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] [PII], this is not a network plan. I have given you the benefit information for this plan.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] You're asking me the same question and I'm going to have to give you the same response because this is not a network plan.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, ma'am, let me confirm the, so the patient does not have any in-network benefits? Only out of network benefits.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] It's not a network plan, so there are not in-network benefits and there are not out of network benefits.
[CUSTOMER][NEUTRAL] OK, can I get your call reference number?
[AGENT][NEUTRAL] Yes, it would be my name that I gave you along with today's date. And [PII], if you all do file a claim for this number.
[CUSTOMER][NEUTRAL] What was your name?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Could you spell your name?
[AGENT][NEUTRAL] [PII] name [PII], and if you do file a claim for this member with APO once the claim has been processed, you may check claim status by going.
[CUSTOMER][NEUTRAL] Oh