AccountId: 011433970860
ContactId: 243388b1-9076-4789-9648-41b245687ef0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 785119 ms
Total Talk Time (AGENT): 288487 ms
Total Talk Time (CUSTOMER): 269304 ms
Interruptions: 3
Overall Sentiment: AGENT=-0.6, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/02/243388b1-9076-4789-9648-41b245687ef0_20250502T19:24_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, my name is [PII]. I'm calling from provider office looking dental benefits.
[AGENT][NEUTRAL] Sure, I can assist you with dental benefits. Um, and I'm sorry, can you repeat your name?
[CUSTOMER][NEUTRAL] Yes, [PII]
[AGENT][NEUTRAL] OK. And may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][NEUTRAL] OK. May I have the patient's policy number?
[CUSTOMER][NEUTRAL] 02612980.
[AGENT][NEUTRAL] Thank you. And what's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Yes, first name is [PII] and last name.
[CUSTOMER][NEUTRAL] [PII] and date of birth is [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] You have a specific question?
[CUSTOMER][NEUTRAL] Ma'am, uh, yes, I have full breakdown. I need a
[CUSTOMER][NEUTRAL] Dental benefit, and what's the uh dental maximum and family deductible?
[AGENT][NEUTRAL] OK, let me get that for you one moment.
[AGENT][NEUTRAL] OK, and this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer.
[AGENT][NEUTRAL] And with this one we have.
[AGENT][NEUTRAL] 750 is the maximum benefit.
[AGENT][NEUTRAL] And we have a
[CUSTOMER][NEUTRAL] $150?
[AGENT][NEUTRAL] $750.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, with the $50 deductible?
[CUSTOMER][NEUTRAL] Uh, uh, ma'am, family deductible.
[AGENT][NEUTRAL] 150 if it's a family plan.
[CUSTOMER][NEUTRAL] OK, and nothing.
[AGENT][NEUTRAL] I'm sorry, you said in the.
[AGENT][NEUTRAL] What information?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Yes, uh ma'am, how much use patient dental maximum individual and family deductible?
[AGENT][NEUTRAL] You want me to repeat it again? OK. The calendar year maximum is $750. The individual deductible is $50 the family deductible is $150.
[CUSTOMER][NEUTRAL] OK, ma'am, there is any waiting period and Missing class?
[AGENT][NEGATIVE] There is a missing tooth clause. There's no waiting period. This one is just a basic dental policy. It doesn't have any major service.
[CUSTOMER][NEGATIVE] Major service is not covered.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. And what is the percentage permanent basic and orthodontic?
[AGENT][MIXED] Although it's not covered, implants are not covered.
[AGENT][NEUTRAL] Um, preventative cover 100%.
[AGENT][NEUTRAL] Radiograph FMX is covered at 80%. Basic expense and basic restorative expenses covered at 80%. And again, there's no major, so endodontics, periodontics, prostheonic repair, and oral surgeries are not covered.
[CUSTOMER][NEUTRAL] OK, and um uh uh 2391 filling is downgrade.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 23, I'm sorry, I didn't get what you said.
[CUSTOMER][NEGATIVE] 2, yes, yes, 2391 is downgrade.
[AGENT][NEUTRAL] Oh, no, there's no downgrades.
[CUSTOMER][NEUTRAL] OK, ma'am. Thank you, ma'am. Uh ma'am, uh, I have called just need percentage and frequency.
[AGENT][NEUTRAL] Hm
[AGENT][NEUTRAL] OK, I need it one by one.
[CUSTOMER][NEUTRAL] OK, no problem. Postcode is [PII].
[AGENT][NEUTRAL] 0 120, that's oral evaluation. It's gonna be under preventative, which is 100%, and that one is going to be, let's see, unlimited to two oral evaluation procedures in any combination of 120, 140, 150, 160 for 12 month period.
[CUSTOMER][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] 212. OK, ma'am. 11:10.
[AGENT][NEUTRAL] 1110 that's gonna be once every 6 months and that is gonna be under preventative.
[CUSTOMER][NEUTRAL] And every check. OK, ma'am. 0274.
[AGENT][NEUTRAL] 274 0274, that's gonna be under preventative, which is 100%. And that one is going to be limited to one bite when X-ray procedure in any combination of 270, 272, or 274 for 12 month period.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] One per month.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh, ma'am, uh 0330.
[AGENT][NEUTRAL] 0330. That's going to be on the radiograph FMX which is 80% and it's limited to one X-ray procedure and any combination of 210, 277, or 330 for a five-year period.
[CUSTOMER][NEUTRAL] Uh, uh, frequency limitation?
[AGENT][NEUTRAL] You said 330 correct?
[CUSTOMER][NEUTRAL] And can you
[CUSTOMER][NEUTRAL] Uh, can you repeat the frequency and limitation? 0330?
[AGENT][NEUTRAL] That's under Radiograph FMX.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Which is covered at 80%.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And that will be limited to one X-ray procedure and any combination of 210, 277, or 330 per 5-year period.
[CUSTOMER][NEUTRAL] I do not know one but uh OK.
[CUSTOMER][NEUTRAL] And 0.
[CUSTOMER][NEUTRAL] It frequency, ma'am, uh it is shared with the 01 uh bat wing, right? 0274.
[AGENT][NEGATIVE] No, uh uh, no, no, no, no, no. Limited to one X-ray procedure and any combination of 210, 277, or 330 for 5-year period. This is not a bite one, this is a um
[AGENT][NEUTRAL] Hao.
[CUSTOMER][POSITIVE] Great
[AGENT][NEUTRAL] Panel chairs with FMX, not with by wings.
[CUSTOMER][NEUTRAL] OK. 1 procedure to 10 radio.
[AGENT][NEUTRAL] 210, OK.
[CUSTOMER][NEUTRAL] Explain that to me now.
[AGENT][NEUTRAL] Yeah, that is um part of that.
[CUSTOMER][NEUTRAL] Uh uh
[CUSTOMER][NEUTRAL] OK. Uh, my, uh, it means, uh, I could not understand the frequency like 1 past 12 months, 1 for 60 months, 1 for 6 months. It is.
[AGENT][NEUTRAL] 11 per 5 years, 1 per 5 years.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] OK. Thank you, thank you. Bye.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh, ma'am, next is 1206.
[AGENT][NEUTRAL] That's another code.
[CUSTOMER][NEUTRAL] Yes, 13 1.
[CUSTOMER][NEUTRAL] 206 right.
[AGENT][NEUTRAL] OK, 1206 is not covered.
[CUSTOMER][NEGATIVE] Not covered 1355.
[CUSTOMER][NEUTRAL] 705726
[AGENT][NEUTRAL] 1355 is not covered.
[CUSTOMER][NEUTRAL] Not covered, OK.
[CUSTOMER][NEUTRAL] 4341.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] office.
[AGENT][NEUTRAL] 4341 4341 is not covered.
[CUSTOMER][NEUTRAL] 4910. Yeah.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] 4910 is not covered.
[CUSTOMER][NEUTRAL] 435-5.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] 4346.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] And Indo 3330.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] Do not covered and uh oral surgery, 7210.
[AGENT][NEUTRAL] OK.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] Ma'am, and 7951.
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] 7953
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] 426 7
[AGENT][NEUTRAL] OK, um, mister, um, I, we do not cover endoonics or periodontics under this policy.
[CUSTOMER][NEUTRAL] OK. Is Last code is uh 9944.
[AGENT][NEUTRAL] Mhm
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] One.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Uh, ma'am, uh, tell me the last, uh, date.
[CUSTOMER][NEUTRAL] History example of the battering FMX.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] OK, so you need the history?
[CUSTOMER][NEUTRAL] Yes, yes.
[AGENT][NEUTRAL] OK, there's no history for this number.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] Um, no history.
[CUSTOMER][NEUTRAL] And ma'am, and tell me the group number.
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] The group number is let me see.
[AGENT][NEUTRAL] 70084
[CUSTOMER][NEUTRAL] 70084 and
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Group name.
[AGENT][NEUTRAL] The group name is Serge Staffing.
[CUSTOMER][NEUTRAL] Then
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Search
[AGENT][NEUTRAL] Surge staffing.
[CUSTOMER][NEUTRAL] Ma'am, second
[AGENT][NEUTRAL] Search staffing.
[CUSTOMER][NEUTRAL] Uh, can you, ma'am, can you spell the uh second word after search?
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] Staffing, S T A F F I N G.
[CUSTOMER][NEUTRAL] T A F F I N G.
[CUSTOMER][NEUTRAL] Staffing.
[AGENT][NEUTRAL] Yes.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] S T A F F I N. OK and uh tell me the PR ID.
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] 081. OK, ma'am. And ma'am, it is calendar year or benefit year?
[AGENT][NEUTRAL] Calendar year.
[CUSTOMER][NEUTRAL] OK. And ma'am, uh your deductible applies to which services?
[AGENT][NEUTRAL] Deductible applies to all no preventatives. The preventatives are the only ones that doesn't apply under that deductible.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] Uh, deductible applies to basic and preventive services, right, ma'am?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] Deductible applies to radiograph, mm mm, OK, uh, radiograph, FMX, basic expense, and basic restorative expense. So deductible does not apply to preventative. Mhm.
[CUSTOMER][NEUTRAL] It is applies to be.
[CUSTOMER][NEUTRAL] OK, thank you, ma'am. OK, OK, OK. And uh
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh, tell me, what is your name?
[AGENT][NEUTRAL] My name is [PII], and that initial is [PII].
[CUSTOMER][NEUTRAL] OK, reference number, ma'am?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in the estate if you will.
[CUSTOMER][POSITIVE] Thank you, ma'am.