AccountId: 011433970860
ContactId: 29f2b782-a699-49b1-844b-6ff5036fb3c2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 385820 ms
Total Talk Time (AGENT): 129095 ms
Total Talk Time (CUSTOMER): 129762 ms
Interruptions: 0
Overall Sentiment: AGENT=-0.1, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/13/29f2b782-a699-49b1-844b-6ff5036fb3c2_20250613T17:14_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon, [PII]. My name is [PII], and I call you for the dental office. I need to verify the eligibility for a patient.
[AGENT][NEUTRAL] Hey [PII], I can help you with eligibility. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Yeah, sure, [PII], no extension.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, you have the policy number for the patient?
[CUSTOMER][NEUTRAL] Yeah, sure, uh, it's 02625536.
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Uh, yeah, the patient name is [PII], and date of birth, um, is, uh, [PII].
[AGENT][NEUTRAL] Yeah, it looks like this policy is active and effective [PII].
[CUSTOMER][NEUTRAL] OK, this plan work like a PPO plan or it's like a HMO or discount plan?
[AGENT][NEUTRAL] Um, they have a PPO network they can utilize which is Carrington.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] It's for dental. Are you calling for dental benefits?
[CUSTOMER][NEUTRAL] Yeah, dental yeah right mhm.
[CUSTOMER][NEUTRAL] OK, can I have the maximum of this plan and what is the deductibles and the percent for preventive basic and major?
[AGENT][NEUTRAL] Um, I can send over a fax back that outlines all of that information plus breaks down all of the codes that are covered.
[AGENT][NEUTRAL] Um, do you have a fax number or do you need to go over it on the phone?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Yeah, sure.
[CUSTOMER][NEUTRAL] Um, can we do both fax and by phone?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] OK, uh, when you're ready I can give you the fax, yeah.
[AGENT][NEUTRAL] Uh, what's your facts?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and then for this policy, it's not a guarantee of payment, it's a basic outline of the plan.
[AGENT][NEUTRAL] Um, they have a $500 calendar year maximum benefit.
[AGENT][NEUTRAL] Preventative services pay 100%.
[AGENT][NEUTRAL] Um, FMX pano, and radiographs, so X-rays that pays 80% after a $50 deductible.
[AGENT][NEUTRAL] And then they only have coverage for basic and basic restorative expenses, so, and that pays 80% after that same deductible.
[CUSTOMER][NEUTRAL] OK, so there are any, there are no any cover cover sorry for May or end of period or a surgery or even implant.
[AGENT][NEUTRAL] That's correct. The only oral surgery that's covered would be code 7140 under basic.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And can I ask for some frequency?
[AGENT][NEUTRAL] Uh, yes.
[CUSTOMER][NEUTRAL] OK, um, the 0 120.
[AGENT][NEUTRAL] Is that the cleaning or the exam?
[CUSTOMER][NEUTRAL] No, the exam 0120.
[AGENT][NEUTRAL] Um, the exam is 2 for 12 month period. Cleanings are once every 6 months.
[CUSTOMER][NEUTRAL] The 1110
[AGENT][NEUTRAL] Yes, and then bite wings once for 12 months.
[AGENT][NEUTRAL] And full mouth and pano is once every 5 years.
[CUSTOMER][POSITIVE] And those that are covered 100%.
[AGENT][NEUTRAL] No, the pro fees and exams are covered at 100%.
[AGENT][NEUTRAL] Um, X-rays are covered at 80%.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] After a $50 deductible.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, OK.
[CUSTOMER][NEUTRAL] Mhm, so there are no cover for the 4910, right?
[AGENT][NEGATIVE] Yeah, there's no coverage.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, and this plan has any maximum?
[AGENT][NEUTRAL] 500
[CUSTOMER][NEUTRAL] 500
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Sorry, I don't hear you well. The, the maximum what is?
[AGENT][NEUTRAL] 500
[CUSTOMER][NEUTRAL] 500 OK.
[CUSTOMER][NEUTRAL] And 50% deductible, right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK perfect and can I have the payer payer ID for this policy?
[AGENT][NEUTRAL] Your ID is 60801.
[CUSTOMER][NEUTRAL] OK and the address?
[AGENT][NEUTRAL] The address is [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um-hum.
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK perfect uh can I have the reference number for this call?
[AGENT][NEUTRAL] The reference number is my name, [PII], first initial to last name [PII], and today's date.
[CUSTOMER][POSITIVE] OK perfect.
[CUSTOMER][POSITIVE] OK, thank you so much, [PII]. Uh, can you send me those benefits through fire, OK, thank you.
[AGENT][NEUTRAL] Yes, let me verify your facts real quick. [PII]?
[CUSTOMER][NEUTRAL] Oh sure.
[CUSTOMER][POSITIVE] Yes, that's right. That's definitely, thank you.
[AGENT][NEUTRAL] OK. Anything else I can help with today?
[CUSTOMER][POSITIVE] No, that's all thank you so much.
[AGENT][POSITIVE] OK, thanks for calling APL. Have a great weekend.
[CUSTOMER][NEUTRAL] You too bye.
[AGENT][NEUTRAL] Bye bye