AccountId: 011433970860
ContactId: 20e68496-968b-42dc-a456-013c0054e666
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 216550 ms
Total Talk Time (AGENT): 90133 ms
Total Talk Time (CUSTOMER): 108330 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/20/20e68496-968b-42dc-a456-013c0054e666_20250320T15:54_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, I'd like to go over my patient's um dental eligibility and benefit information.
[AGENT][POSITIVE] Sure, I can assist you with that. Can I have your name and a callback number?
[CUSTOMER][NEUTRAL] This is [PII] callback number [PII].
[AGENT][NEUTRAL] [PII], can I have the policy number of the member that you're inquiring eligibility for today?
[CUSTOMER][NEUTRAL] Yes, I have 01714266.
[AGENT][NEUTRAL] Can you verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] Uh, name is [PII]. Date of birth [PII].
[AGENT][NEUTRAL] This policy has been active since [PII] and it's currently active. You're calling to verify benefits and eligibility.
[CUSTOMER][NEUTRAL] Correct. 14.
[AGENT][NEUTRAL] The maximum benefit amount is $1500 per calendar year with a $50 deductible that does not apply to preventative services.
[AGENT][NEUTRAL] Preventative services.
[CUSTOMER][NEUTRAL] 0 1600.
[AGENT][NEUTRAL] 151,500.
[CUSTOMER][POSITIVE] Oh, fit 15. OK. Thank you.
[AGENT][NEUTRAL] And this is not a guaranteed benefits just a disclaimer of the policy's coverage.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Preventative is covered at 100%, basic at 80, and major at 40.
[CUSTOMER][POSITIVE] All righty.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] She has no history on file, nor has she utilized any of her benefits for [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh wow OK no history on file.
[AGENT][NEUTRAL] We have a dental schedule that we can send over to you by fax as well.
[CUSTOMER][NEGATIVE] I'm so sorry you're, you're cutting off.
[AGENT][NEUTRAL] There's a dental schedule that I can send to you by fax if you would like.
[CUSTOMER][NEUTRAL] Um, I think I received that, uh, the other day. Let me check to see if it's the same one. It, it has all the covered codes, but, um, all of them have like letter, um.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Letters in parentheses.
[CUSTOMER][NEUTRAL] Codes like
[CUSTOMER][NEUTRAL] Yes, correct, that's it, right?
[AGENT][NEUTRAL] So those letters in parentheses are the limitations and on the very last page there's a box explaining each of those letters within parentheses for the limitations for each procedure code.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Yes, I have that thank you.
[CUSTOMER][NEUTRAL] Uh, I have some other questions. Uh, let's see here. Is this the patient's secondary insurance?
[AGENT][NEUTRAL] This is. I'm not sure we're not affiliated with any other one, however, there is a coordination of benefit.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I see, uh, let's see. OK, so the patient because the patient does not have any history on file, they have not used or met any of their annual maximum or deductible for the year?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, um, let's see anything else? Uh, can I talk to [PII]? OK, I think that is all, or let me double check one more thing before you go. There are no orthodontic benefits on this patient's policy, is that correct?
[AGENT][NEUTRAL] It's correct, there isn't.
[CUSTOMER][NEUTRAL] OK, alrighty, can I get your name and a reference number please?
[AGENT][NEUTRAL] My name is [PII] and unfortunately we don't provide reference numbers. [PII], it's S as [PII], H as [PII], and you can use my name in today's date as a reference.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][POSITIVE] OK perfect thank you very much [PII]. I hope you have a wonderful rest of your day.
[AGENT][POSITIVE] Thank you for calling APL. You have a great one as well, [PII]. Goodbye.
[CUSTOMER][NEUTRAL] Bye bye.