AccountId: 011433970860
ContactId: 1b9ec67c-452a-488f-8d01-f3f5d6746c4f
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 386000 ms
Total Talk Time (AGENT): 162423 ms
Total Talk Time (CUSTOMER): 110454 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.1, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/14/1b9ec67c-452a-488f-8d01-f3f5d6746c4f_20250314T20:20_UTC.wav
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[AGENT][POSITIVE] Thank you for contacting APO. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling on behalf of the dental office to check eligibility and benefits for a patient.
[AGENT][NEUTRAL] OK, I can certainly help with the eligibility benefits. What's that policy number, please?
[CUSTOMER][NEUTRAL] Yes, that is 02583342.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] It's [PII]. Date of birth is [PII].
[AGENT][POSITIVE] I appreciate that. If I could just have a callback number please, in the event that we're disconnected.
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] Thank you very much. It looks like your policy went into effect on [PII]. It is active. Now you wanted to know about benefits as well as eligibility. The policy has $500 per calendar year as the maximum. That is just a verification of those benefits, not a guarantee of payments, and it covers basic, basic, restorative, and preventative services only. So there's, there's no major coverage, there's no endedonics, no periodontal services, um.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] But it does cover the basics, uh, and it doesn't look like [PII] has used any of her benefits at all. Now, I do have a fax that I can send to you, or is there anything in particular I could tell you about this policy?
[CUSTOMER][NEUTRAL] Yes, uh, so, um, what would be the group name and the group number for this?
[AGENT][NEUTRAL] Yes, the group name, or excuse me, the group number for the policy is 700.
[AGENT][NEUTRAL] 72
[AGENT][NEUTRAL] And the group name.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Is hospitality staffing.
[CUSTOMER][NEUTRAL] Got it. And is it a single or a family coverage?
[AGENT][NEUTRAL] It looks like this is, uh, I believe it's a family coverage. Just let me check. Yes, this is for her family.
[CUSTOMER][NEUTRAL] And what will be the claim's mailing address?
[AGENT][NEUTRAL] It's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] That is in [PII].
[AGENT][NEUTRAL] The zip code is [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] All right. And uh do you accept assignment of benefits to a non-participating provider?
[AGENT][NEUTRAL] Uh, there's, we don't, uh, do, I mean, you, you can send it in, yes, we don't, uh, it doesn't really matter, but yeah, we'll, we'll go ahead and take it if it's assigned, that's fine.
[CUSTOMER][NEUTRAL] And if benefits are exhausted, do in-network provider discounts apply?
[AGENT][NEGATIVE] No, they do not.
[CUSTOMER][NEUTRAL] And for non-coverage services, does the discount apply?
[AGENT][NEGATIVE] Uh, no, there, there would be no benefits if it's not covered.
[CUSTOMER][NEUTRAL] All right. And uh do we have any deductible?
[AGENT][NEUTRAL] There's a $50 deductible that does not apply to the preventative services.
[CUSTOMER][NEUTRAL] OK. And uh what will be the co-insurance for preventative and basic?
[AGENT][NEUTRAL] The preventative is at 100% and the basic and basic restorative is at 80%.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] And just to confirm, uh, oral surgery and simple extraction, those are also not covered, right?
[AGENT][NEGATIVE] Those would not be covered.
[CUSTOMER][NEUTRAL] Got it. And just to confirm for 4910, is it covered?
[AGENT][NEUTRAL] Uh, let me just check here.
[AGENT][NEGATIVE] No, that is not going to be covered.
[CUSTOMER][NEUTRAL] OK. And is there a missing tooth loss?
[AGENT][NEGATIVE] There is a missing tooth cloth, yes.
[CUSTOMER][NEUTRAL] And do we have any uh downgrade on this plan for fillings?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] And uh lastly, [PII], I do have um 4 codes to check. I only need the frequency. So do you need all the codes at once or one by one?
[AGENT][POSITIVE] Uh this one by one would be fine.
[CUSTOMER][NEUTRAL] OK, so the first is 0150.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] That is, let's see.
[AGENT][NEUTRAL] That is going to be um
[AGENT][NEUTRAL] 2 for 12 month period.
[CUSTOMER][NEUTRAL] Got it. Next is 0274.
[AGENT][NEUTRAL] I don't show that that's covered this, let me check here.
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] 0274. Uh, excuse me, I do have have it in a different number, yeah. So bye wings, the bite wings are going to be um
[AGENT][NEUTRAL] Uh, once for 12 month period.
[CUSTOMER][NEUTRAL] All right. Next is uh 0 to 10.
[AGENT][NEUTRAL] That is once for 5-year period.
[CUSTOMER][NEUTRAL] Got it. And the last is 1208.
[AGENT][NEUTRAL] 1, I'm sorry, 108.
[CUSTOMER][NEUTRAL] 1208.
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] That's the fluoride. OK, let's see.
[AGENT][NEUTRAL] That is um once for 12 months.
[CUSTOMER][NEUTRAL] Got it.
[CUSTOMER][NEUTRAL] All right and just to confirm, um, there's no waiting period on this plan, right?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] Got it. And so, I've been with all my questions and you can provide me the reference number to our call.
[AGENT][NEUTRAL] Yes, my name is [PII]. The first letter of my last name is [PII]. We're gonna use that in today's date as a reference.
[CUSTOMER][POSITIVE] Got it. And [PII], thank you so much for your assistance and have a wonderful day ahead.
[AGENT][POSITIVE] Mhm thanks for contacting API.