AccountId: 011433970860
ContactId: 1970ccd7-717d-4cbb-a95b-be63ba5a127d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 273450 ms
Total Talk Time (AGENT): 122237 ms
Total Talk Time (CUSTOMER): 81916 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/19/1970ccd7-717d-4cbb-a95b-be63ba5a127d_20250219T17:39_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. This is [PII] calling from Reubin Associates to verify the eligibility and benefits of a patient. How are you doing today, [PII]?
[AGENT][NEUTRAL] I'm fine. And you say your name is [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, I can verify benefits and eligibility for you. What's that policy number?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Yeah, the policy number will be 2288041.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Yeah, the callback number will be [PII].
[AGENT][NEUTRAL] OK, thank you, [PII], and verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] First name will be [PII] and the last name will be [PII].
[CUSTOMER][NEUTRAL] And the date of birth will be [PII].
[AGENT][NEUTRAL] OK, thank you. And this is for dental?
[CUSTOMER][NEUTRAL] Yeah, for dental?
[AGENT][NEUTRAL] OK. Um, I show effective date of [PII], policy is active. Now you just need a general breakdown of benefits or I can send a fax back.
[CUSTOMER][NEUTRAL] Yeah, I have some questions. Can you can go with that?
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, what would be the individual and family deductibles and our max dollar amount?
[AGENT][NEUTRAL] Uh, not a guarantee of payment, just a verification of coverage. The patient has a benefit max up to $1500 per calendar year and a $50 deductible that is applied to everything but preventative services. There is not a family max since it's only him on the plan.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and what would be the coincidence for preventative basic major?
[AGENT][NEUTRAL] Uh, UCR is 100, uh, uh, pays 100% of UCR for preventative.
[AGENT][NEUTRAL] 80% for basic and 40% for any major services which would include endo perio oral surgery, crowns, bridges, partials, and dentures.
[CUSTOMER][NEUTRAL] Yeah, and
[CUSTOMER][NEUTRAL] I need in-network benefits for this patient.
[AGENT][NEUTRAL] Uh, we don't have a network.
[CUSTOMER][NEUTRAL] 180 and 50, right?
[AGENT][NEUTRAL] 18,040.
[CUSTOMER][NEUTRAL] 180 and 40, yeah, just give me a moment, yeah, and what would be the group name and group number?
[AGENT][NEUTRAL] One moment.
[AGENT][NEUTRAL] Group number 15586. Group name is Universal Trucking America Midwest.
[CUSTOMER][NEUTRAL] American Midwest, OK.
[CUSTOMER][NEUTRAL] And the effective date will be [PII], correct me.
[AGENT][POSITIVE] Uh, correct.
[CUSTOMER][NEUTRAL] And is there any orthodontic benefits?
[AGENT][NEGATIVE] Or that it's not covered.
[CUSTOMER][NEUTRAL] OK. And from the $1500 anything has been used?
[AGENT][NEUTRAL] Uh, no, I'm not sure they have used their benefit nor met their deductible for the year.
[CUSTOMER][NEUTRAL] OK, and can you check if there is any history which affects the frequency?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] I'm showing the last, well, that won't affect the frequency. Last bite wing and exam was on [PII].
[AGENT][NEUTRAL] And
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][NEUTRAL] Correct. And last cleaning was [PII], so that wouldn't affect their frequency.
[CUSTOMER][NEUTRAL] Frequency. Mhm.
[AGENT][NEUTRAL] And let's see.
[AGENT][NEUTRAL] Yeah, they don't show a history of FMX.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, nor panel, so.
[CUSTOMER][NEUTRAL] Yeah, OK.
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] Yeah. Thank you, [PII]. And what would be the call reference number?
[AGENT][NEUTRAL] Uh, we don't give reference numbers. If you like, you may use my name at today's date. And [PII], is there anything else I can assist you with today?
[CUSTOMER][POSITIVE] Yeah, thank you, [PII]. Thank you for your assistance. I'm done with my patient. Bye. Have a nice day.
[AGENT][POSITIVE] You're welcome. Thank you for calling [PII]. Bye.
[CUSTOMER][NEUTRAL] Yeah, bye.