AccountId: 011433970860
ContactId: 2b08f4cc-467e-4660-851f-207ddafb68ec
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 738760 ms
Total Talk Time (AGENT): 171708 ms
Total Talk Time (CUSTOMER): 124965 ms
Interruptions: 3
Overall Sentiment: AGENT=1.1, CUSTOMER=-1.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/2b08f4cc-467e-4660-851f-207ddafb68ec_20250619T12:50_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, good morning, my name is [PII]. I'm calling from provider's office regarding the policy.
[AGENT][POSITIVE] OK, well, I'll be more than happy to help you with the policy, and [PII], can you spell your first name for me, please?
[CUSTOMER][NEUTRAL] Sure it's [PII]
[AGENT][POSITIVE] Thank you. May I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Um, yes, it's gonna be 262-356-3.
[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] [PII] or [PII] date of birth is [PII].
[AGENT][NEUTRAL] Um, can you provide the, the policyholder's name and
[AGENT][NEUTRAL] Date of birth?
[CUSTOMER][NEUTRAL] [PII] date of birth is [PII].
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment and
[AGENT][NEUTRAL] Do you mind if I place you on just a brief hold?
[CUSTOMER][NEUTRAL] Sure.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Wait a minute.
[AGENT][NEUTRAL] Is it a family or
[AGENT][NEUTRAL] So who else is in the family?
[AGENT][NEUTRAL] OK, wait a minute
[AGENT][NEUTRAL] I see.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Mhm, did you know.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] doing a phone call.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Policy sir on on base. 00000.
[AGENT][NEUTRAL] All right.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] You are
[AGENT][NEUTRAL] Hello [PII].
[CUSTOMER][NEUTRAL] Yes, is everything OK?
[AGENT][POSITIVE] Yes, thank you so much for holding. I apologize for that wait. So the on like our main screen where everyone shows up, it only showed the policyholder, which is why I asked you to verify him. It doesn't show like spouse, children, but when I go to where the benefits are, it says family. So I'm like, well, is it a family or is it just [PII]? So I was just making sure that I can give benefits, so I'm going to get that corrected so everybody that's covered on the policy shows.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, um, sure thing.
[AGENT][NEUTRAL] And how may I assist you today?
[CUSTOMER][NEUTRAL] Um, so I had already called previously and I did get a fax back and they were able to locate um the dependent on the policy.
[CUSTOMER][NEUTRAL] Um, I needed to confirm some information.
[AGENT][NEUTRAL] Yes, she, I saw the notes that she shouldn't have did that. I'm sorry.
[CUSTOMER][NEUTRAL] Oh OK um.
[CUSTOMER][NEUTRAL] As far as the yearly uh max.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Which is 750, um, the preventative services come out of that.
[AGENT][NEUTRAL] So, OK, so let, let's just go over it together because for this policy, the max is not $750 it's $500.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEGATIVE] So the fax back is incorrect. Yes. Mhm.
[AGENT][NEUTRAL] You want to just go over the facts. The fax back is the same. No, OK, so the fax back is correct, but the, there's two different policies that use this fax back. There's a high and a low. The 750 is for the other policy type.
[CUSTOMER][POSITIVE] Got it OK.
[CUSTOMER][NEUTRAL] OK, so they faxed me the wrong one then?
[AGENT][MIXED] It's the right one, but where they put 750, they should have put 500, that's all.
[CUSTOMER][NEUTRAL] 500? OK.
[CUSTOMER][NEUTRAL] Let me
[AGENT][POSITIVE] Sorry about that.
[CUSTOMER][NEUTRAL] And does the um the preventative services come out of that?
[AGENT][NEUTRAL] Out of the yearly max, yes, but there's no deductible applied for preventative.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then is there any major coverage on this policy?
[AGENT][NEUTRAL] No, ma'am. Um, only preventative, radiograph and FMX, and Basic.
[CUSTOMER][NEUTRAL] OK, so procedure codes that are not listed on this are not covered, is that?
[AGENT][NEUTRAL] No, no, no, so that's what I was checking on. Say that again.
[CUSTOMER][POSITIVE] Pretty safe to say.
[CUSTOMER][NEUTRAL] Um, can you check some codes for me to see if they're covered?
[AGENT][NEUTRAL] Oh, sure, um, but yes, to answer your question, if they're not on this facts back, then they're not covered by the policy, but I can definitely go over them for you.
[CUSTOMER][NEUTRAL] Um, can you check the code D 3220?
[AGENT][NEUTRAL] OK, so that's not on this fax back, so it wouldn't be covered.
[CUSTOMER][NEUTRAL] At about [PII].
[AGENT][NEUTRAL] 2930.
[AGENT][NEUTRAL] No, it's also not on here.
[CUSTOMER][NEUTRAL] Um, what about 2391?
[AGENT][NEUTRAL] That's under basic restorative at 80%, um.
[AGENT][NEUTRAL] Replace existing only if in place for 24 months. And what's the other limitation, maximum of 1 each tooth per 24 months.
[CUSTOMER][NEUTRAL] And what about on posterior teeth, is it downgraded or apaceases?
[AGENT][NEUTRAL] Um, there's no downgrades.
[CUSTOMER][NEUTRAL] OK, and then does he have any waiting periods the dependent?
[AGENT][NEUTRAL] Um, no waiting periods because the policy doesn't cover major services.
[CUSTOMER][NEUTRAL] And then is there any or coverage?
[AGENT][NEUTRAL] Um, or, orthodontic treatment is not covered.
[CUSTOMER][NEUTRAL] And then could I get the effective date?
[AGENT][NEUTRAL] Sure, hold on one moment.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And then the yearly max renews on a calendar year?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, um, that should be all I needed thank you for your help.
[AGENT][POSITIVE] You're very welcome. Well, thanks [PII]or calling APL. I hope you have a great day.
[CUSTOMER][NEUTRAL] You as well.
[AGENT][POSITIVE] Thank you.