AccountId: 011433970860
ContactId: 2b31f283-e88a-4922-b212-2f6942f66804
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 312140 ms
Total Talk Time (AGENT): 72318 ms
Total Talk Time (CUSTOMER): 151930 ms
Interruptions: 1
Overall Sentiment: AGENT=1.5, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/2b31f283-e88a-4922-b212-2f6942f66804_20250404T14:54_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, yes, I was just calling to verify if somebody is still active.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, I can help you with eligibility. Could I get your name and a good callback number?
[CUSTOMER][NEUTRAL] It's [PII] and it's [PII].
[AGENT][NEUTRAL] OK, thank you, [PII]. Do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] I do it's 246-1345.
[AGENT][NEUTRAL] And patient name and date of birth.
[CUSTOMER][NEUTRAL] Yes, that is going to be for [PII] and it's [PII].
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, looks like this policy was effective [PII], and it is currently active.
[CUSTOMER][NEUTRAL] OK, and then I just wanna verify one thing hold on sorry, let me get back to my screen.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, um, is group number still 70069?
[AGENT][NEUTRAL] Oh
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, and then I just need to verify a few new things for the [PII] if that's OK with you?
[AGENT][NEUTRAL] OK, um, let me get the benefits pulled up.
[CUSTOMER][NEUTRAL] we just haven't, OK, yeah, we just haven't re-verified this plan for this year yet, so I just wanna re-verify it.
[AGENT][NEUTRAL] Sure
[AGENT][NEUTRAL] OK, this is not a guarantee of payment, basic outline of the policy. Um, what, what can I verify?
[CUSTOMER][NEUTRAL] OK, so the annual max is still 500?
[AGENT][NEUTRAL] Yes, it is.
[CUSTOMER][NEUTRAL] OK, and deductibles are still 50 and 150 for the family?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] Preventative diagnostic at 100, basic at 80, and major is not covered, including endoperio and oral surgery.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, and then I have 0140 at 80%, is that correct?
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] And then I also need to know if the deductible applies to that.
[AGENT][NEUTRAL] Yes, um, 0140 is 80%, and yes, the deductible does apply.
[CUSTOMER][NEUTRAL] OK perfect um and then do all the exams share frequency like 0150 0120 and the 0140?
[AGENT][POSITIVE] Um, yes, that's correct.
[CUSTOMER][NEUTRAL] OK, um, and are all of them at 80% or just the 0140?
[AGENT][NEUTRAL] Just a 0140.
[CUSTOMER][NEUTRAL] OK, so the deductible does apply to exams but only 0140. OK, just wanna make sure, sorry, I just have to put in these specifics. I'm so sorry.
[AGENT][NEUTRAL] No, you're fine. I can send another fax back to you if that's helpful.
[CUSTOMER][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] That's OK. I just have, um, sorry, I only have like 2 or 3 more questions.
[AGENT][NEUTRAL] That
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, I just want myself know this that it does apply to 01.
[CUSTOMER][NEUTRAL] 40 only.
[CUSTOMER][NEUTRAL] OK and then let's see here.
[CUSTOMER][NEUTRAL] X-rays are 80% and it does the deductible apply to X-rays as well.
[AGENT][NEUTRAL] Right
[AGENT][POSITIVE] Yes, it does.
[CUSTOMER][POSITIVE] Or at least, OK, and then bite wings is 100% correct.
[AGENT][NEUTRAL] Uh, bite wings are.
[AGENT][NEUTRAL] Yes, they are.
[CUSTOMER][NEUTRAL] OK, so the deductible does not apply by lying, just all the other X-rays that are at 80%, correct? OK, perfect. And then I've got let's see.
[AGENT][NEUTRAL] Oh.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Uh, 1354 is not covered. That is correct, correct.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Uh, yes, not pulling up that code.
[CUSTOMER][NEUTRAL] OK, and posterior composites do not downgrade?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] And is um 2991 covered on this plan?
[AGENT][NEUTRAL] I'm not pulling up that code either.
[CUSTOMER][NEUTRAL] OK, and I just wanna verify that period maintenance is not covered on this plan as well because it's considered major, right?
[AGENT][POSITIVE] Um, looks like that is correct.
[CUSTOMER][POSITIVE] OK, perfect. That is actually all I needed um I just need a reference number and there's no ortho, no waiting period as well, correct?
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, yeah, just a reference number and that's all I need.
[AGENT][NEUTRAL] OK, reference number will be my first name [PII], first initial last name [PII], and today's date.
[CUSTOMER][POSITIVE] Thank you so much, [PII]. I appreciate your help and you have a great day.
[AGENT][POSITIVE] Thanks for calling APL. You too. Bye.
[CUSTOMER][NEUTRAL] Bye.