AccountId: 011433970860
ContactId: 22d5794d-9cd1-473f-abae-63d81343a243
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 595669 ms
Total Talk Time (AGENT): 160569 ms
Total Talk Time (CUSTOMER): 221159 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/22d5794d-9cd1-473f-abae-63d81343a243_20250305T19:50_UTC.wav
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[AGENT][POSITIVE] Thank you for calling APL. My name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hello, [PII]. This is [PII] calling you from the Paul Street Dental. How are you doing today?
[AGENT][POSITIVE] I'm good how are you?
[CUSTOMER][POSITIVE] Yes, I'm doing great. Thanks for asking. I'm calling for the dental eligibility and benefits for a patient, [PII].
[AGENT][POSITIVE] I'd be happy to assist with benefits and eligibility today, [PII], if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, sure, it will be [PII]. It's your direct line.
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Yes, the policy number will be 023268-885.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] I'm sorry, repeat that for me.
[CUSTOMER][NEUTRAL] Yeah, sure. It's 023268-885.
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] It's uh [PII] And for the date of birth, [PII].
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment. I do show the policy is currently active. Effective date is [PII]. And were you needing a fax back breakdown of the benefits?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Can you help me on the call for this patient?
[CUSTOMER][POSITIVE] Possible for you.
[AGENT][NEUTRAL] OK, now the only thing we wouldn't give verbally is coding and frequency.
[CUSTOMER][NEUTRAL] OK, you can't help me with the percentage of fragrance, right?
[AGENT][NEUTRAL] But anything else can give.
[AGENT][NEUTRAL] I'm sorry, repeat that?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah, you mentioned the codes. You can't help me with the percentage and frequency on the call, right?
[AGENT][NEUTRAL] Not verbally, we fax those over.
[CUSTOMER][NEUTRAL] Uh yeah, OK, so send me the fax for that one and.
[AGENT][NEUTRAL] What's that fax number?
[CUSTOMER][NEUTRAL] The remaining thing I will collect it from the card will be 310.
[CUSTOMER][NEUTRAL] 929
[CUSTOMER][NEUTRAL] Sorry, I think that's not the right one. Sorry. It's 310.
[CUSTOMER][NEUTRAL] And then [PII].
[AGENT][NEUTRAL] I'm sorry, what's that the 310?
[CUSTOMER][NEUTRAL] 861-1759.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, you should receive that within the next 7 to 10 minutes.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Is there anything else I can assist with today?
[CUSTOMER][NEUTRAL] Yes, so for the remaining, yeah, firstly, can you help me with the group number?
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] Group number is 17626.
[AGENT][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Yes, uh, just give me a second. I'm looking up to.
[CUSTOMER][NEUTRAL] Loading here, so that's fine.
[CUSTOMER][NEUTRAL] The calendar year plan.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] Patients a subscriber.
[AGENT][NEUTRAL] Uh, dependent.
[CUSTOMER][NEUTRAL] Dependent
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] You mentioned at American Public Life Insurance, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And can you help me with the claim mailing address?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that's in [PII].
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEUTRAL] And the zip code is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII]. OK. And the group number.
[CUSTOMER][NEUTRAL] That's and the group name will be?
[AGENT][NEUTRAL] Universal Trucking.
[CUSTOMER][NEUTRAL] And Universal and after that tracking T R A C K I N G.
[AGENT][NEUTRAL] I'm sorry, repeat that.
[CUSTOMER][NEUTRAL] OK can you spell the last part of the universal?
[AGENT][NEUTRAL] The last 4 you said what?
[CUSTOMER][NEUTRAL] What, uh, like after universal?
[AGENT][NEUTRAL] Oh, trucking Universal Trucking is the name of the group.
[CUSTOMER][NEUTRAL] P R A C K I N G.
[AGENT][NEUTRAL] Yes, T R U C K I N G Trucking.
[CUSTOMER][NEUTRAL] The tracking and the payer ID will be?
[AGENT][NEUTRAL] 60801
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Can you help me with the deductible annual max for out of network?
[AGENT][NEUTRAL] Annual max is $1500 per calendar year and the family deductible is $150. Individual deductible is $50.
[CUSTOMER][NEUTRAL] Timely filing limits will be per month.
[AGENT][NEGATIVE] There's no timely filing.
[CUSTOMER][NEUTRAL] And assignment of benefits.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Coordination of benefits standard and non duplicate.
[AGENT][NEUTRAL] I'm sorry, repeat that.
[CUSTOMER][NEUTRAL] A coordination of benefit.
[CUSTOMER][NEUTRAL] And a non duplicate?
[AGENT][NEUTRAL] It would be standard.
[CUSTOMER][NEUTRAL] Is there any pre-authorization or predetermination amount?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] Is there any waiting period?
[AGENT][NEUTRAL] Um, they've exhausted the waiting period. They've been with us more than a year.
[CUSTOMER][NEUTRAL] Can you help me with the effective date once?
[AGENT][NEUTRAL] Effective date is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And you mentioned nothing has been used from the deductible annual max?
[AGENT][NEUTRAL] Uh, for the calendar year is what you're asking?
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Like for the deductibles also is.
[AGENT][NEGATIVE] No, they haven't used anything. No, they haven't um used anything and they haven't met their deductible for the year.
[CUSTOMER][NEUTRAL] Can you help me?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, thank you. Can you help me for orthodontic lifetime max coverage and age limit if it is covered?
[AGENT][NEGATIVE] Ortho is not covered.
[CUSTOMER][NEUTRAL] Not covered, OK.
[CUSTOMER][NEUTRAL] And the coinsurance for preventive basic and major for out of network?
[AGENT][NEUTRAL] Um, preventative is covered at 100%. Basic is covered at 80%, and major is covered at 40%.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] 40. OK. Is there any missing tooth cloth?
[AGENT][NEGATIVE] Yes, there's a missing tooth cloth.
[CUSTOMER][NEUTRAL] Major surgeries will be paid on pre of the date.
[AGENT][NEUTRAL] I'm sorry, repeat that for me.
[CUSTOMER][NEUTRAL] Uh, for major surgeries, it will be paid on the date or date.
[AGENT][NEUTRAL] C
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] All exam sharing frequency including 0140?
[AGENT][NEUTRAL] Uh, frequencies is, um, on the fax but we don't do that by phone.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK, bronze downgrade.
[AGENT][NEUTRAL] We don't do John grades.
[CUSTOMER][NEUTRAL] For SRP, how many quadrants can be done on the visit?
[AGENT][NEUTRAL] Um, all 4.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And composite filling downgraded to amalgam.
[AGENT][NEUTRAL] I didn't quite understand. Can you repeat that for me?
[CUSTOMER][NEUTRAL] Uh, for composites link downgraded to amalgam.
[AGENT][NEUTRAL] We don't do downgrades.
[CUSTOMER][NEUTRAL] Uh, like 4 2160. OK.
[CUSTOMER][NEUTRAL] Hold on, wait.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][POSITIVE] And then I think almost I got the information which I needed and
[CUSTOMER][NEUTRAL] For the history, is there any history?
[CUSTOMER][NEUTRAL] Only for preventive.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] [PII], um.
[AGENT][NEUTRAL] They had code 1110 and 150.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And that's it.
[CUSTOMER][NEUTRAL] 150, OK.
[CUSTOMER][NEUTRAL] OK, that's the only history it's affecting, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Thank you. Uh, and I just want to make sure like all the quotes will be listed in the facts, right, for the preventive basic nature and oral surgeries.
[AGENT][NEUTRAL] Correct, if you don't see a code on the fax that means it's not covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, that will be not covered. OK, so yeah, thank you. Finally, we are done with the patient. I just need your name and the reference number for all.
[AGENT][NEUTRAL] Reference is just my name [PII] last initial [PII], and the date and time of the call.
[CUSTOMER][POSITIVE] OK. Thank you, [PII] for the assistance and have a wonderful day.
[AGENT][POSITIVE] Thank you for calling APL have a good day.