AccountId: 011433970860
ContactId: 2e935675-0837-40f6-b72f-22c03e997167
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 227919 ms
Total Talk Time (AGENT): 121801 ms
Total Talk Time (CUSTOMER): 68936 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/03/2e935675-0837-40f6-b72f-22c03e997167_20250203T16:08_UTC.wav
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[AGENT][NEUTRAL] Contacting HTL, my name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, I need to check if a patient of ours has um dental coverage.
[AGENT][POSITIVE] I can certainly help uh with benefits, and with whom am I speaking, please?
[CUSTOMER][NEUTRAL] This is [PII].
[AGENT][NEUTRAL] [PII], thank you. What's that policy number we're looking at today?
[CUSTOMER][NEUTRAL] Um, policy number is 02516823.
[AGENT][NEUTRAL] Thank you. And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] It's for [PII], date of birth of [PII].
[AGENT][NEUTRAL] OK, thank you. Um, I do have to ask if there's a callback number, please, in the event that we're disconnected?
[CUSTOMER][NEUTRAL] Yes, callback number is [PII].
[AGENT][NEUTRAL] Thank you. And this policy went into effect on [PII]. It is active. This is a dental policy. Um, Kala has $1500 for calendar years and maximum. That's just a verification of those benefits, not a guarantee of payment, and what it covers is basic, basic restorative, and uh it will cover um major services as of [PII].
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Now is there, I do have a fax I can send to you or if there's anything in particular that I could tell you about this dental policy?
[CUSTOMER][NEUTRAL] Um, the facts would be, the facts would be good. Um, you mentioned that it just covers basic and major, correct?
[AGENT][POSITIVE] It covers what it does is it covers um basic.
[AGENT][NEUTRAL] Basic restorative and preventative services. Now, there will be major coverage um as of [PII]. It's just that there's a 12 month waiting period on that which has not been met yet.
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so 12 months, uh, waiting period.
[CUSTOMER][NEUTRAL] Um, well, the fax, let me know if the, um, any resins downgrade.
[AGENT][POSITIVE] That's correct, yes, it will.
[CUSTOMER][NEUTRAL] OK, and then will it also give me the payer ID?
[AGENT][NEUTRAL] Uh yes, um, our payer ID, by the way, is 60801.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 60.
[CUSTOMER][NEUTRAL] OK, I'll go ahead and uh
[CUSTOMER][NEUTRAL] Request that fax, please.
[AGENT][NEUTRAL] Sure. What's your fax number?
[CUSTOMER][NEUTRAL] It's [PII].
[CUSTOMER][NEUTRAL] 7571861
[AGENT][NEUTRAL] Thank you. Um, now, I'll, I'll go ahead and send this to you right now, uh, [PII], um, in case you have any questions on here. But is there anything else I can tell you while I'm on the phone?
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Um, what would be the plan name be?
[AGENT][NEUTRAL] It's American Public Life.
[CUSTOMER][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is there a certain fee schedule that the insurance goes by?
[AGENT][NEUTRAL] What we do is we go by a percentage of UCR. So, um, for the preventative services, it's 100% of UCR for basic and basic restorative, it's 80%. And when the major coverage is is due or when, when it's available, I should say, it will be at 40%.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Now, uh, as far as Clony is concerned, um, I don't show any history. So on the preventative services that you see, you, they will all be available.
[CUSTOMER][NEUTRAL] Mm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. I think that's all my questions as of right now.
[AGENT][POSITIVE] OK, [PII], you should be getting that just a second. Again, my name is [PII] with American Public Life. Just let me know if there's anything else that we can do for you. Otherwise, thanks for contacting API. You have a good morning.
[CUSTOMER][NEUTRAL] OK.