AccountId: 011433970860
ContactId: 29ce5194-ba9e-4cc0-b352-28d922c1b4dd
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 400779 ms
Total Talk Time (AGENT): 139553 ms
Total Talk Time (CUSTOMER): 85973 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/15/29ce5194-ba9e-4cc0-b352-28d922c1b4dd_20250115T14:45_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII], this is [PII] calling from A Dental. How are you doing today, [PII]?
[AGENT][POSITIVE] I'm doing well. How are you?
[CUSTOMER][POSITIVE] I'm doing good, thanks for asking.
[AGENT][NEUTRAL] And um I missed your name. Can you repeat your name for me, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] Thank you for that. and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII] direct line.
[AGENT][POSITIVE] Thank you for that and how may I assist you today?
[CUSTOMER][NEUTRAL] I have, I have a patient for dental benefits.
[AGENT][NEUTRAL] You want to go over dental benefits?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah, it's gonna be.
[CUSTOMER][NEUTRAL] 023-39023
[AGENT][NEUTRAL] Thank you, hold on one moment.
[AGENT][NEUTRAL] And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And did you need a copy of the fax back or you have particular questions?
[CUSTOMER][NEUTRAL] Particular questions. First of all, may I know the deductibles ERA max and the coinsurance percentages?
[AGENT][NEUTRAL] I'm sorry, can you give your request slowly? Can you repeat that, please?
[CUSTOMER][NEUTRAL] Yeah, deductibles, yearly max percentages.
[AGENT][NEUTRAL] OK, so the calendar year max for this policy is $1500 per covered insured.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The deductible is $50 per covered insured, up to $150 per family.
[AGENT][NEUTRAL] The deductible does not apply to preventative expenses?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This policy has been active since [PII].
[AGENT][NEUTRAL] Preventative is covered at 100%.
[AGENT][NEUTRAL] Radio graphs and FMX, basic expenses and basic restorative expenses are all at 80%.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Major expenses, which includes endodontic, periodontic, proteodontic, and oral surgery are all at 40%.
[AGENT][NEUTRAL] With a 12-month waiting period.
[CUSTOMER][NEGATIVE] Oh no.
[CUSTOMER][POSITIVE] Yeah, thank you. And uh can I get the deductibles one more time and you and the family deductible.
[AGENT][NEUTRAL] $50 per covered insured.
[AGENT][NEUTRAL] Up to 150 per family.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][NEUTRAL] It's
[AGENT][NEUTRAL] Did you need the waiting period?
[CUSTOMER][NEUTRAL] 1 2nd
[CUSTOMER][NEUTRAL] Yeah, is there any waiting period?
[AGENT][NEUTRAL] There's a 12-month waiting period for the major expenses, um, that was satisfied though in [PII], so they passed the waiting period.
[CUSTOMER][NEUTRAL] 1 2nd.
[CUSTOMER][NEUTRAL] That
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEGATIVE] Nothing has been used and nothing has been made right.
[AGENT][NEUTRAL] Um, let me check for this year. Hold on one moment.
[AGENT][NEUTRAL] Correct, um, he has not used any of the max or met the deductible for [PII].
[CUSTOMER][NEUTRAL] Is the orthodontics is a covered benefit?
[AGENT][NEUTRAL] Um, orthodontic treatment is not covered.
[CUSTOMER][NEUTRAL] Do you see any preventative history?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Do you see any preventative history?
[AGENT][NEUTRAL] Do you have codes for that? We have to look it up by codes.
[CUSTOMER][NEUTRAL] Yeah, 0120.
[CUSTOMER][NEUTRAL] 1110.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] 0
[AGENT][NEUTRAL] OK, and what's the list of codes you have?
[CUSTOMER][NEUTRAL] 0120.
[CUSTOMER][NEUTRAL] 11:10.
[CUSTOMER][NEUTRAL] 0210
[CUSTOMER][NEUTRAL] 4341.
[AGENT][NEUTRAL] That's it.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] for
[CUSTOMER][NEUTRAL] right
[AGENT][NEUTRAL] OK, so I'm not showing any history with those codes.
[CUSTOMER][NEUTRAL] Yeah and uh group number and the group name.
[AGENT][NEUTRAL] The group number is 14481.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] The group name is Universal Trucking Transport Design.
[CUSTOMER][NEUTRAL] Yeah and uh.
[CUSTOMER][NEUTRAL] Spell out your name.
[AGENT][NEUTRAL] My name is [PII]
[AGENT][NEUTRAL] First initial to my last name is [PII].
[CUSTOMER][NEUTRAL] Call reference.
[AGENT][NEUTRAL] There's no call reference number, but you can use my name and today's date.
[CUSTOMER][POSITIVE] Thanks for the information. Bye for now, [PII].
[AGENT][POSITIVE] You're very welcome and thanks for calling APL. Bye bye.
[CUSTOMER][NEUTRAL] Yeah.