AccountId: 011433970860
ContactId: 14f45faf-3e50-45f6-8c0d-9668143f3b5f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 449769 ms
Total Talk Time (AGENT): 172940 ms
Total Talk Time (CUSTOMER): 161907 ms
Interruptions: 1
Overall Sentiment: AGENT=1.1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/10/14f45faf-3e50-45f6-8c0d-9668143f3b5f_20250110T15:40_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm just calling to get some benefit information for a patient.
[AGENT][POSITIVE] Sure, [PII], I could assist you with that. I have a callback number for you.
[CUSTOMER][NEUTRAL] Yes, [PII] and it would be option 2.
[AGENT][NEUTRAL] And the policy number of the member that you're in current eligibility for.
[CUSTOMER][NEUTRAL] Yes, 024518571.
[AGENT][NEUTRAL] It's too many there's too many numbers. Could you repeat that again?
[CUSTOMER][NEUTRAL] Yeah, 024518571.
[AGENT][NEUTRAL] [PII], I do apologize. Could you verify the policy number that's listed on the card? because there's too many numbers. It's not pulling up a policy.
[CUSTOMER][NEUTRAL] OK, let me double check his account.
[CUSTOMER][NEUTRAL] Just going by what he told us was on his card I believe.
[CUSTOMER][NEUTRAL] Are you able to search by name and date of birth by chance?
[AGENT][NEUTRAL] What's the, what's the member's social? Do you have the social?
[CUSTOMER][NEUTRAL] I don't, but I can call him and try and get it.
[AGENT][NEUTRAL] What is his last name? Could you spell his last name and then spell his first name?
[CUSTOMER][NEUTRAL] Yep, last name is [PII]
[CUSTOMER][NEUTRAL] And first name is [PII]
[AGENT][NEUTRAL] What city and state does [PII] live in?
[CUSTOMER][NEUTRAL] What was that it was cutting out.
[AGENT][NEUTRAL] What city and state does [PII] live in?
[CUSTOMER][NEUTRAL] Um, the [PII].
[AGENT][NEUTRAL] Is this for dental?
[CUSTOMER][NEUTRAL] One to remember.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Can you verify his date of birth?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] So let me give you the correct policy number.
[CUSTOMER][POSITIVE] OK, I'm ready whenever you are.
[AGENT][NEUTRAL] It is 2451871. It's 2451871.
[CUSTOMER][NEUTRAL] OK, and I'll let him know when he comes in for his visit.
[AGENT][NEUTRAL] This policy has been active since [PII] and it's currently active.
[CUSTOMER][NEUTRAL] OK perfect what's the birth name on the plan?
[AGENT][NEUTRAL] Universal Trucking.
[CUSTOMER][NEUTRAL] And group number?
[AGENT][NEUTRAL] 121 55.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Let's see this is.
[AGENT][NEUTRAL] This policy has a maximum benefit amount of $1500 per calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] With a $50 deductible that does not apply to us preventative services.
[AGENT][NEUTRAL] This is not a guaranteed benefits, just a disclaimer of the policy's coverage.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, this is let me see what's the claim address on this plan?
[AGENT][NEUTRAL] The claim address will be addressed to APL claims department.
[AGENT][NEUTRAL] [PII]. That's [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] And you said the individual deductible was $50 that hasn't been met and then he's a talent.
[AGENT][NEUTRAL] Yes, up to 150 per family.
[CUSTOMER][NEUTRAL] OK, and then a calendar maximum of 1500?
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] OK, does he have any ortho coverage?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No, OK, but he has preventative, basic, and major any waiting periods on this plan?
[AGENT][NEUTRAL] He did have a 12 month waiting period, but let me verify if it has been exhausted.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] So his waiting period does not exhaust for major services until [PII]. So the policy will only cover preventative and basic services, preventative at 100 and basic at 80.
[CUSTOMER][NEUTRAL] OK, let me just write that down.
[AGENT][NEUTRAL] I can send you a fax back if you would like.
[CUSTOMER][NEUTRAL] Yeah, let me just, there may, let me just see if there's any other questions um I need like before you go that won't be on the fax and then that would be perfect um you said there's just a it's just a 12 month waiting period on major?
[AGENT][NEUTRAL] Yes. Endoeroprosthesis or surgery, crowns, bridges.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, so those all have, so let me put those as 12 months, so that'll be up in [PII] though, OK.
[AGENT][POSITIVE] Yeah, that's correct.
[CUSTOMER][NEUTRAL] And he does have implant coverage after that 12 month waiting period?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No? OK.
[CUSTOMER][NEUTRAL] And then for major endopperio and oral surgery, what percentage will it be after his waiting period?
[AGENT][NEUTRAL] 40%
[CUSTOMER][NEUTRAL] For all of them.
[AGENT][POSITIVE] Yes, that is correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, and is there a missing tooth clause on this plan?
[AGENT][NEUTRAL] There is listed on the very first page of the fax that that I'm gonna send over for you. Actually on the very first page it's gonna have the policy number, yearly cal the calendar max, the deductible, the category of expenses.
[CUSTOMER][NEUTRAL] OK, well.
[AGENT][NEUTRAL] Um, frequencies where to submit a claim.
[AGENT][NEUTRAL] The list of procedures that's covered, the descriptions, and then there's gonna be letters in parentheses under the limitation column which express the limitations for each procedure code and on the very last page there's a box with each letter in parentheses expressing the limitation for each alphabet.
[CUSTOMER][POSITIVE] OK perfect yeah.
[CUSTOMER][POSITIVE] OK perfect that's good. Do you need my uh fax back number?
[AGENT][POSITIVE] Yes, that would be very helpful.
[CUSTOMER][NEUTRAL] OK, 386.
[CUSTOMER][NEUTRAL] [PII] and how long does that take to come on over?
[AGENT][NEUTRAL] I'm not sure it's sent by the right fax, so you had gave me [PII].
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] It shouldn't take all day though.
[AGENT][NEUTRAL] I've never had someone to say that it took all day.
[CUSTOMER][NEUTRAL] OK, um, and then can I just get the spelling of your first name and a reference number for the call?
[AGENT][NEUTRAL] [PII] [PII], and today's date is a reference error because we don't provide reference numbers unfortunately.
[CUSTOMER][NEUTRAL] OK, that's fine, um.
[CUSTOMER][POSITIVE] [PII] alright perfect.
[AGENT][NEUTRAL] Is there anything else that I can assist you with today?
[CUSTOMER][POSITIVE] Um, that'll be it. I appreciate your help.
[AGENT][POSITIVE] You're welcome. Thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Thanks. Goodbye.