AccountId: 011433970860
ContactId: 13dc4514-2335-4f0b-9e9f-cd6213b0e140
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 359089 ms
Total Talk Time (AGENT): 122666 ms
Total Talk Time (CUSTOMER): 107620 ms
Interruptions: 0
Overall Sentiment: AGENT=1.6, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/17/13dc4514-2335-4f0b-9e9f-cd6213b0e140_20250617T20:30_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, my name is [PII] calling from Jefferson Dental. How are you doing today?
[AGENT][POSITIVE] Good, how are you?
[CUSTOMER][POSITIVE] I'm doing great, thanks for asking.
[AGENT][POSITIVE] Great. How can I help you?
[CUSTOMER][NEUTRAL] Yeah, actually, I'm checking to verify the eligibility and benefits of only one patient. Could you please help me on that?
[AGENT][POSITIVE] Yes, I can help with eligibility and benefits. [PII], do you have a good callback number?
[CUSTOMER][NEUTRAL] That's [PII]. It's a direct line.
[AGENT][NEUTRAL] Policy number of the patient?
[CUSTOMER][NEUTRAL] It's 2492082.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, the patient's first name is [PII] and the last name is [PII] with the date but [PII].
[AGENT][NEUTRAL] Policy is effective [PII]. It's currently active.
[AGENT][POSITIVE] And I can fax over a fax back that outlines all the frequency, duration, coverage schedule and amount, um, or all the codes that are covered.
[AGENT][NEUTRAL] Unless there's something.
[CUSTOMER][NEUTRAL] Uh, are you, uh, the effective date.
[CUSTOMER][NEUTRAL] Uh, effectively you said that is [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Uh, are you able to give the benefits by verbal?
[AGENT][NEUTRAL] Are you needing codes or are you not allowed to have a fax?
[CUSTOMER][NEUTRAL] And, uh, actually I need by verbal.
[CUSTOMER][NEUTRAL] Only one patient. I'll complete within 10 minutes 2 minutes, sorry, 2 minutes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, uh, so they have a, uh, not a guarantee of payment basic outline of the policy. There's a $1500 calendar year maximum.
[AGENT][NEUTRAL] Preventative services pay 100%.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And FMX basic basic restorative pay 80% after a $50 deductible.
[AGENT][NEUTRAL] Family deductibles 150.
[CUSTOMER][NEUTRAL] And uh what is the major percentage?
[AGENT][NEUTRAL] Major endopperio, prosthodontic repair, and oral surgery all pays 40%. There is a 12-month waiting period for major.
[CUSTOMER][NEUTRAL] OK, uh, and also could you please confirm with the group number and group name?
[AGENT][NEUTRAL] Um, group number is.
[AGENT][NEUTRAL] 15844.
[AGENT][NEUTRAL] And the group name is Universal Trucking, Superior bulk.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK. Uh, the payer ID would be 60801, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Each patient is a policyholder?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. And also, let me confirm once again, uh, the individual is [PII] and the family is 150, yearly max is 1500, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. The coin insurance percentages of preventative basic measure would be 180, 40.
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] OK, uh, the original effective date is [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Um, and also, could you please confirm that, uh, is there any, uh, used amount from the deductibles and yearly ma?
[AGENT][POSITIVE] I'm sorry, what was the question? I'm so sorry.
[CUSTOMER][NEUTRAL] OK, uh, not a problem. Uh, is there any use zone accumulations from the deductibles and yearly max?
[AGENT][NEUTRAL] Uh, let me see.
[AGENT][NEUTRAL] Uh, the only thing they've used so far, nothing for this year, um, but they did have a full mouth and bite wing on [PII].
[CUSTOMER][POSITIVE] Cool.
[CUSTOMER][NEUTRAL] [PII] for byte wings and FMX right?
[AGENT][NEUTRAL] Yes, and the FMX frequency is once every 5 years.
[AGENT][NEUTRAL] By wing is once per 12 month period.
[CUSTOMER][NEUTRAL] OK, and also could you please confirm that um.
[CUSTOMER][NEUTRAL] Is there any uh waiting period or missing too clothes?
[AGENT][NEUTRAL] Uh, the waiting period is 12 months, yeah, for the major, and then there is a missing tooth clause, yes.
[CUSTOMER][NEUTRAL] Sorry, you already said.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 12 months waiting period for major.
[CUSTOMER][NEUTRAL] There is a missing tooth cloth, OK. And uh apart from that, is there any other history?
[AGENT][NEUTRAL] Uh, no, that's all that there is.
[CUSTOMER][NEUTRAL] OK, I have two quotes. Could you please confirm with the frequency and the percentages?
[AGENT][NEUTRAL] Uh, yes, what is that?
[CUSTOMER][NEUTRAL] 610497953
[AGENT][NEUTRAL] OK, 61, I'm sorry, 61.
[CUSTOMER][NEUTRAL] 6104
[AGENT][NEUTRAL] 6104, it's not covered.
[CUSTOMER][NEUTRAL] 79
[CUSTOMER][NEUTRAL] 7953.
[AGENT][NEGATIVE] Uh, not covered.
[CUSTOMER][NEUTRAL] OK, could you please confirm with your name and also the call reference number?
[AGENT][NEUTRAL] Uh, my name is [PII], and then the call reference will be my name, [PII]. First initial to last name is [PII], and today's date.
[CUSTOMER][POSITIVE] OK, thank you, [PII]. Have a great day. Bye-bye. Take care.
[AGENT][POSITIVE] Thank you for calling APL. You as well. Bye-bye.