AccountId: 011433970860
ContactId: 26f31127-69e6-4a7f-97d9-7fb2ff8913bd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 332040 ms
Total Talk Time (AGENT): 157317 ms
Total Talk Time (CUSTOMER): 160113 ms
Interruptions: 1
Overall Sentiment: AGENT=0.7, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/24/26f31127-69e6-4a7f-97d9-7fb2ff8913bd_20250124T22:11_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help?
[CUSTOMER][NEUTRAL] Yes
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling on behalf of the dental office to check the eligibility and benefit for a member on a recorded line. Could you please help me with that?
[AGENT][NEUTRAL] Yeah, I can check eligibility and benefits. I'm sorry, what did you say your name was?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, uh, [PII], can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Callback number is [PII].
[AGENT][NEUTRAL] Alright, thank you. Do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, sir. The policy number is 02451919.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Alright, and what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] Sure, it's uh [PII] with the date of birth of [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that [PII]. Uh, so this policy is active. Effective date was [PII], and if you'd like, I can send you a copy of the fax back that shows all covered procedures and benefit information.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] It would be great if we give the benefit of the call and I'm having a few eligibility questions which I need to check. So firstly, what about the network status for the provider?
[AGENT][NEUTRAL] Could you repeat that? I'm sorry.
[CUSTOMER][NEUTRAL] What about the network status for the provider?
[AGENT][NEUTRAL] Yes, we are the uh providers so this this plan does not have its own network it just goes off of UCR.
[CUSTOMER][NEUTRAL] UCR all right and.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So is the member the subscriber? Yeah, is what about the group name by the way?
[AGENT][NEUTRAL] Yes, [PII] is the subscriber um the group name is Universal Trucking.
[CUSTOMER][NEUTRAL] Right
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] Halvor, it's H A L V O R Lines.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK, and the group number?
[AGENT][NEUTRAL] 21742.
[CUSTOMER][NEUTRAL] And the date of birth is
[CUSTOMER][NEUTRAL] [PII], right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And is it a family plan or a single coverage plan?
[AGENT][NEUTRAL] It is a family plan.
[CUSTOMER][NEUTRAL] And uh, just a moment.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, and can you just uh once you have a plan.
[CUSTOMER][NEUTRAL] You said it's an indemnity plan and what about the claim and address by the way?
[AGENT][NEUTRAL] It is [PII] 248,950.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] $500 range.
[AGENT][NEUTRAL] That is in [PII].
[AGENT][NEUTRAL] Zip code is [PII].
[CUSTOMER][NEUTRAL] Are
[CUSTOMER][NEUTRAL] And I'm really sorry, could you please repeat the effective date one more time? [PII], right?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] [PII], yes.
[CUSTOMER][NEUTRAL] OK, and could you please repeat the group name and the group number 11 more time?
[AGENT][NEUTRAL] Uh, yeah, give me just a moment.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] And that.
[AGENT][NEUTRAL] Group name is Universal Trucking.
[CUSTOMER][NEUTRAL] Is that
[AGENT][NEUTRAL] Halvor lines.
[CUSTOMER][NEUTRAL] All right, I got that.
[CUSTOMER][NEUTRAL] And the group number?
[AGENT][NEUTRAL] 21742.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][POSITIVE] OK, amazing. And
[CUSTOMER][NEUTRAL] And the [PII] you you gave me is [PII], right?
[AGENT][NEUTRAL] Yes, that's correct, and I've also got a uh fax number. Yes, I've got a fax number and a pair ID um our payer ID is 60801.
[CUSTOMER][NEUTRAL] What about the payer ID?
[CUSTOMER][NEUTRAL] So
[CUSTOMER][POSITIVE] OK, great.
[CUSTOMER][NEUTRAL] And just a few more questions by the way, what about the deductible, the max on this plan?
[AGENT][NEUTRAL] Of course, right, and I will let you know, uh, verification of coverage is not a guarantee of payment for claims. Their calendar year maximum is $1500 per covered insured.
[AGENT][NEUTRAL] The deductible is $50 per covered insured up to $150 per family, and that does not apply to preventative expenses.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I've been used on it?
[AGENT][NEUTRAL] Uh, give me just a moment, let me check that.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Um, [PII] has not used any of that. One of the members did meet, uh, the $50 deductible though.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] But for this number, the deductible hasn't been met yet, right? Is orthodontic service covered?
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] No, orthodontic treatment is not covered.
[CUSTOMER][NEUTRAL] OK, what about the coverage for preventative and basic and major?
[AGENT][NEUTRAL] Preventative is 100%.
[AGENT][NEUTRAL] Basic is 80%.
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] And the major is 40%.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] OK, great, thank you for that information. And lastly, could you please help me with your name and the reference number.
[AGENT][NEUTRAL] Reference number would just be my first name, last initial, and today's date and so my name is spelled [PII] Was there anything else I could help you with [PII]?
[CUSTOMER][POSITIVE] All right, amazing. Thank you for the information and thank you for your help.
[AGENT][POSITIVE] Of course, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] You do as well. Bye-bye. Take care.
[AGENT][POSITIVE] You too thank you bye bye.
[CUSTOMER][NEUTRAL] Yes.