AccountId: 011433970860
ContactId: 2eb27d8e-5dd4-4754-9f1c-3c515c64763d
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 400100 ms
Total Talk Time (AGENT): 189754 ms
Total Talk Time (CUSTOMER): 118771 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/07/2eb27d8e-5dd4-4754-9f1c-3c515c64763d_20250207T22:51_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yeah, hi, my name is [PII]. I'm just calling from the provider office. I need to check dental eligibility and benefit for this member, please.
[AGENT][NEUTRAL] Hm
[AGENT][POSITIVE] Yeah, sure, I can assist you with the eligibility and benefits for your dental, Miss [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] The phone number is [PII].
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yes, it's 02488636.
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Beer's name is [PII] and let me check his birthday.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] His birthday, yeah yeah yeah.
[CUSTOMER][POSITIVE] Oh happy.
[CUSTOMER][NEUTRAL] His birthday is [PII].
[CUSTOMER][NEUTRAL] ADA
[CUSTOMER][NEUTRAL] Yes, [PII].
[AGENT][POSITIVE] Yeah, OK. Thank you.
[AGENT][NEUTRAL] And you need the eligibility and benefits given to you verbally or faxed over to you?
[CUSTOMER][NEUTRAL] Uh, if because right now I don't know what happened, but the fax is not going through.
[AGENT][NEUTRAL] OK. OK. I can go ahead and give you a verbal breakdown. And this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK bear with me just a second, let me see.
[AGENT][NEUTRAL] I'm waiting for the breakdown of benefits to pull up, OK? One moment.
[CUSTOMER][NEUTRAL] For the ones
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, so this is 5001.
[AGENT][NEUTRAL] All right, so the, let me go ahead and give you the effective date is [PII]. It is showing active at the moment.
[AGENT][NEUTRAL] And this is one of our basic dental policy. Um, with this basic dental policy, there is a calendar year maximum of $500 with the calendar year deductible of $50 and deductible does not apply to preventative.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Um, this policy covers preventative, radiograph, basic and basic restorative. It doesn't have any major service, so endodontics, periodontics, prosthey repair, and or surgery are not covered under this policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Preventative start cover 100%.
[AGENT][NEUTRAL] Radiograph FMXs cover 80%.
[AGENT][NEUTRAL] Basic expense and basic restorative is covered at 80%.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And for the cleaning, we have once every 6 months, evaluation, 2 for 12 month period.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] By wings once for 12 month period.
[AGENT][NEUTRAL] And full mouth X-ray, so panel is once every 5 years.
[CUSTOMER][NEUTRAL] OK, in this case he has only $500 maximum and then $50 deductible for the calendar year.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct, yes.
[CUSTOMER][NEUTRAL] OK, uh, for the call 4341 is covered?
[AGENT][NEUTRAL] No, nothing on the [PII]. Um, there's no periodontics or endodontics.
[CUSTOMER][NEUTRAL] It's not covered. OK.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Oh, OK. And then he has um he has a history for that?
[AGENT][NEUTRAL] I can check on the history.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, so, uh, for the history, we have
[AGENT][NEUTRAL] Let's see. We have an X-ray that was done on [PII], was the 210.
[AGENT][NEUTRAL] And we have an oral evaluation of 150 on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] No, that's the only thing under the history.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK, they, they cover for the full mouth X-ray?
[AGENT][NEUTRAL] Um, what is the code?
[CUSTOMER][NEUTRAL] The code is 0210.
[AGENT][NEUTRAL] OK, so this one is going to be on the radiograph FMX which is 80% after the deductible and it's limited to one X-ray procedure in any combination of 210, 277, or 330 per 5-year period.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But in this case they covered only for X-rays, exam, and fillings.
[CUSTOMER][NEUTRAL] I'm very um profy.
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, can I, can I have your name please?
[AGENT][NEUTRAL] My name is [PII]. That's [PII].
[CUSTOMER][NEUTRAL] So
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] That's, that's your name so.
[AGENT][NEUTRAL] Yeah, it's so.
[AGENT][NEUTRAL] That's initial [PII]. Mhm.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][NEUTRAL] Oh, OK.
[CUSTOMER][NEUTRAL] OK, thank you for your help. The other to the one we send the the.
[AGENT][NEUTRAL] Mm
[AGENT][POSITIVE] You're welcome
[CUSTOMER][NEUTRAL] The claim is uh [PII].
[AGENT][NEUTRAL] Mhm. [PII]. Correct, yes.
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] You're welcome. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] That's it thank you so much.
[AGENT][POSITIVE] You're welcome and thank you for calling APR. Have a good day, Miss [PII].
[CUSTOMER][POSITIVE] You too thank you bye.
[AGENT][POSITIVE] You're welcome. Bye bye.