AccountId: 011433970860
ContactId: 27ce051d-2ccc-45ff-b80d-5978e79b0415
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 241479 ms
Total Talk Time (AGENT): 67873 ms
Total Talk Time (CUSTOMER): 67568 ms
Interruptions: 0
Overall Sentiment: AGENT=0.7, CUSTOMER=1.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/27ce051d-2ccc-45ff-b80d-5978e79b0415_20250411T16:31_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Yes, my name is [PII]. I'm just checking the eligibility for a patient please.
[AGENT][NEUTRAL] OK, [PII], I can help you with eligibility. Do you have a good callback number?
[CUSTOMER][POSITIVE] Thank you, yes, [PII].
[AGENT][NEUTRAL] OK, thank you. And policy number of the patient?
[CUSTOMER][NEUTRAL] Yes, that's gonna be 02596197.
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] Um, it's gonna be [PII], uh, [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And you just needed eligibility or do you need benefits as well?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, just to confirm that the plan is still active and if they've used any of the maximum for the year.
[AGENT][NEUTRAL] Uh, it looks like the policy is effective [PII] currently active, and let me see if they've used anything.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Give me just one moment.
[CUSTOMER][POSITIVE] No worries.
[AGENT][NEUTRAL] Uh, it doesn't look like they've used anything to date.
[CUSTOMER][POSITIVE] Perfect, and that is the $500 maximum, correct?
[AGENT][POSITIVE] Uh, that is correct.
[CUSTOMER][NEUTRAL] Perfect. OK, and then lastly, can you just confirm, um, I don't believe so, but if, uh, fluoride is covered code 1208.
[AGENT][NEUTRAL] Um, let me see.
[AGENT][NEUTRAL] And this is not a guarantee of payment, just a basic outline of the policy. Um, let me see for you said 1208, is that right?
[CUSTOMER][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Um, let's see
[AGENT][NEUTRAL] OK, I do have codes.
[AGENT][NEUTRAL] Um, 12:01.
[AGENT][NEUTRAL] And 1203, those are covered under preventative.
[CUSTOMER][NEUTRAL] Hm.
[AGENT][NEUTRAL] Um, is 12:08 a newer code?
[CUSTOMER][NEUTRAL] No, I just know that that's the fluoride code.
[CUSTOMER][NEUTRAL] Um, I didn't see it on the fax back either, so I assumed there was just no coverage for that.
[AGENT][NEUTRAL] Um, they, they do have coverage for fluoride if it's for those specific codes. It's limited to children under age [PII], max of one procedure for 12 months, but I don't see 1208 on here.
[CUSTOMER][NEUTRAL] Interesting. OK, OK, well, we'll just try to bill it and then see if anything.
[AGENT][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you so much for your help.
[AGENT][NEUTRAL] OK. Anything else I can help with today?
[CUSTOMER][NEUTRAL] No, that's it for today.
[AGENT][POSITIVE] OK, thank you so much for calling APL. I hope you have a good weekend.
[CUSTOMER][POSITIVE] You too thank you bye bye.