AccountId: 011433970860
ContactId: 1d1f1cdf-afed-460a-a0c0-736f92439e38
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 432839 ms
Total Talk Time (AGENT): 207618 ms
Total Talk Time (CUSTOMER): 140384 ms
Interruptions: 2
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/12/1d1f1cdf-afed-460a-a0c0-736f92439e38_20250312T13:18_UTC.wav
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[AGENT][NEUTRAL] For calling APL, this is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, good morning. This is [PII].
[CUSTOMER][NEUTRAL] Hello?
[AGENT][POSITIVE] Yes, I'm here doing. I say good morning. Thanks for calling APL. How may I assist you?
[CUSTOMER][NEUTRAL] Hi.
[CUSTOMER][NEUTRAL] Hi, yeah. Um, I'm just, I need extra help for this patient. I'll be needing some of the coverage and frequency for this one.
[AGENT][POSITIVE] Can I have a callback number for you and that policy number, and I'll be able to assist you.
[CUSTOMER][NEUTRAL] Yeah, sure. So for the policy number of this patient, just give me one second. So that will be
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] All right. So, policy number will be 02596093.
[AGENT][NEUTRAL] And can I have your call back number just in case the call is disconnected?
[CUSTOMER][NEUTRAL] Yeah, sure. So that will be [PII].
[AGENT][NEUTRAL] And could you verify the patient's name and date of birth that you're calling to verify benefits for?
[CUSTOMER][NEUTRAL] Yeah, [PII]. And for the date of birth, that will be [PII].
[AGENT][NEUTRAL] Excuse me.
[AGENT][NEUTRAL] And you said your name was [PII]?
[CUSTOMER][NEUTRAL] Yes, [PII]
[AGENT][NEUTRAL] [PII] or [PII]?
[CUSTOMER][NEUTRAL] [PII] as in dog.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Though you're calling to verify benefits and eligibility, this member's policy has been active since [PII] and it's currently active. The policy is very limited. It only covers preventative and basic services.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Mhm. And can I have the coverage for the preventative and basic services?
[AGENT][NEUTRAL] Preventative is covered at $100. Basic is covered at $80. The maximum yearly maximum is $500 per calendar year with a $50 deductible that does not apply to preventative services, and this is not a guaranteed benefits, just a disclaimer of the policy's coverage, and I can send you a fax back of the benefits if you like.
[CUSTOMER][NEUTRAL] Or
[CUSTOMER][NEUTRAL] Yup, sure.
[AGENT][NEUTRAL] And were there any questions?
[CUSTOMER][NEUTRAL] So actually I just have 6.
[CUSTOMER][NEUTRAL] Yes, I just have 6 codes that I need frequency. Can I have it over the phone?
[AGENT][NEUTRAL] Of course, what is your first procedure code that you want to verify eligibility for?
[CUSTOMER][NEUTRAL] Yes, I just need the frequency for the code 0120.
[AGENT][NEUTRAL] 0120.
[AGENT][NEUTRAL] Limited of two or evaluation procedures and any combination of D0120 D0140 D0150 D0160 per 12 month period. What is your next code on?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] 0274, please.
[AGENT][NEUTRAL] You said 0274?
[CUSTOMER][POSITIVE] Yes, that is correct.
[AGENT][NEUTRAL] Bite wings is once every 12 months.
[CUSTOMER][NEUTRAL] All right. And for the code 1208?
[AGENT][NEUTRAL] 1208. Is that with varnish or without?
[CUSTOMER][NEUTRAL] 0330 frequency, please.
[AGENT][NEUTRAL] 0330.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] So, I just asked you about the 1208 code and I asked you was that with varnish or without varnish?
[CUSTOMER][NEUTRAL] I'm not sure. Um, no indication here. Just, can you just give me any of those ones?
[AGENT][NEUTRAL] So 12:08.
[AGENT][NEUTRAL] Um yeah.
[CUSTOMER][NEUTRAL] Age and frequency, please.
[AGENT][NEUTRAL] Maximum of 1 procedure for 12 months, limited to dependent children aged [PII]. What was your next goal?
[CUSTOMER][NEUTRAL] 0330.
[AGENT][NEUTRAL] Limited to one X-ray procedure of D0210 D0277 and D0330 per five year period.
[CUSTOMER][NEUTRAL] Alright, got it. And can I have the coverage and frequency for the code 2393?
[AGENT][NEUTRAL] 2393.
[AGENT][NEUTRAL] Uh,
[AGENT][NEGATIVE] Falls on the basic, replace existing only if in place for 24 months, maximum of 1 each 2 for 24 months.
[CUSTOMER][NEUTRAL] All right, got it. And for the code 4341 coverage and frequency please.
[AGENT][NEUTRAL] It's not covered under the policy, do.
[CUSTOMER][NEUTRAL] All right. Oh, how about, um, extraction, 7140?
[AGENT][NEUTRAL] Files on the preventative, I'm sorry, on the basic at 80%.
[AGENT][NEUTRAL] Maximum of 1 per 2 per lifetime.
[CUSTOMER][NEUTRAL] All right. How about 7210? Do you cover this one?
[AGENT][NEGATIVE] That's not covered under the policy.
[CUSTOMER][NEUTRAL] Oh my gosh. All right. How about with the Peru maintenance, 4910?
[AGENT][NEUTRAL] Not covered under the policy. So the policy only covers preventative and basic services, endoperiorosthesis or surgery, crowns, bridges, ortho, none of that is covered under the policy. route planning scaling, none of that is covered is very limited.
[CUSTOMER][NEUTRAL] All right, last one, do you cover 9110 coverage and frequency for that?
[AGENT][NEUTRAL] No, that's, you said 9110? What is your description of 9110?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Palliative treatment.
[AGENT][POSITIVE] Thank you. 9110.
[AGENT][NEUTRAL] I was on the basic at 80%, there is no limitation for this procedure code on.
[CUSTOMER][NEUTRAL] Alright, so just to confirm, this is, um, we have $5000 right? And then can I have just your name and reference number for this call?
[AGENT][NEUTRAL] No, 500. No, no, no, ma'am. No, I never stated $5000 is $500 per calendar year, $500 per calendar year.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] All right. All right.
[AGENT][NEUTRAL] And we don't provide reference numbers. However, you can use my name in today's date as a reference. No ma'am, I just didn't want you to get off the phone confused thinking that they have $5000 benefit amount with no major coverage, but it's $500.
[CUSTOMER][NEUTRAL] Do we have, all right, got it. Sorry for that, but
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] All right. Got it. Thank you so much. Can I have your name and reference number for this call, please? Uh, your name again? Can you give me your
[AGENT][NEUTRAL] My name is [PII].
[AGENT][NEUTRAL] [PII] and today's date is a reference because unfortunately we don't provide reference numbers. Is there anything else that I could assist you with today?
[CUSTOMER][NEUTRAL] And today's date. Is that correct?
[CUSTOMER][POSITIVE] Yeah, that's it. Thank you so much. You're so kind. Have a great day.
[AGENT][POSITIVE] Thanks for calling ATL. Have a great day. Bye-bye.