AccountId: 011433970860
ContactId: 2f64d872-8764-40dc-92ba-c6a9c7a4d5f8
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 497649 ms
Total Talk Time (AGENT): 196695 ms
Total Talk Time (CUSTOMER): 105158 ms
Interruptions: 1
Overall Sentiment: AGENT=-0.1, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/17/2f64d872-8764-40dc-92ba-c6a9c7a4d5f8_20250417T17:45_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hello, my name is [PII], and I'm calling for the dental benefits for my patient.
[AGENT][NEUTRAL] OK, sure, I can assist you with dental benefits, Mr. [PII], and may I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] Yeah, it's [PII].
[AGENT][NEUTRAL] OK. Thank you. And what's the name of the facility or the doctor, the provider?
[CUSTOMER][NEUTRAL] Provider's name is Doctor [PII].
[AGENT][NEUTRAL] How do you spell the last name?
[CUSTOMER][NEUTRAL] Uh, it's [PII].
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Yeah, sure. It's 591-952.
[AGENT][NEUTRAL] OK, thank you. One moment.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] What's the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Uh, it's [PII] and date of birth is [PII].
[AGENT][NEUTRAL] OK, thank you. And do you need this information given to you verbally or faxed over to you?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh yeah, I just need that. So, is the plan still active?
[AGENT][NEUTRAL] Yes, we have an effective date of [PII]. It is active at the moment.
[CUSTOMER][NEUTRAL] OK. And what's the annual maximum on the plan?
[AGENT][NEUTRAL] OK, let me check on this 11 moment.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so this is an individual policy. Let me go ahead and get the maximum benefit, OK?
[AGENT][NEUTRAL] This is not a guarantee of payment, just a verification of coverage and that's just a disclaimer. This one has a calendar year maximum of 1000.
[CUSTOMER][NEUTRAL] OK. Has anything been used?
[AGENT][NEUTRAL] For 2025, she has not used her benefits, so she still have the full amount available.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK. And what about deductibles?
[AGENT][NEUTRAL] Deductible is 50.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is there any waiting period or Mr. [PII]?
[AGENT][NEUTRAL] On this one, this one pay based on the um coding because it, it has a pay by code instead of a percentages.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK, so it's based on a schedule.
[AGENT][NEUTRAL] So it really depends on the code.
[AGENT][POSITIVE] Mm correct.
[CUSTOMER][NEUTRAL] Yeah, OK, so.
[CUSTOMER][NEUTRAL] Yeah, I do have some codes. So can you give me the frequency and the amount?
[AGENT][NEUTRAL] OK, give me just a second. Let me go ahead and pull this one because, um, bear with me just a minute.
[CUSTOMER][NEUTRAL] Uh.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] This one is have a look and
[AGENT][NEUTRAL] See, OK.
[CUSTOMER][NEUTRAL] Hello?
[AGENT][NEUTRAL] Yes, I'm here I'm waiting on the information bear with me.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][POSITIVE] All right. OK, and I'm ready for the first code.
[CUSTOMER][NEUTRAL] 0366.
[AGENT][NEUTRAL] OK. 0366.
[AGENT][NEGATIVE] 0366 is not listed, so it's not covered.
[CUSTOMER][NEUTRAL] 0367
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] 0367 is not listed, so it's not covered.
[CUSTOMER][NEUTRAL] 0350
[AGENT][NEGATIVE] 0350 is not covered, it's not listed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 0470
[AGENT][NEUTRAL] Is it 0470?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK, so that's gonna be on the diagnostic. Let me go ahead and get that one.
[AGENT][NEUTRAL] OK, so it looks like that one will pay $76.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] And the frequency?
[AGENT][NEUTRAL] OK, let me get that for you one moment.
[CUSTOMER][POSITIVE] uh, uh, what I'm sorry.
[AGENT][NEUTRAL] OK, so that one is going to be, let's see.
[CUSTOMER][NEUTRAL] Mhm
[AGENT][NEGATIVE] I don't see a frequency of this one.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] 0801.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 801.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] 0801 is not covered.
[CUSTOMER][NEUTRAL] 7956
[AGENT][NEUTRAL] 7956 is not covered?
[CUSTOMER][NEUTRAL] Uh, yeah.
[CUSTOMER][NEUTRAL] OK, yeah, that's it. Does the patient have any history on file that would affect the frequency?
[CUSTOMER][NEUTRAL] You know
[AGENT][NEUTRAL] I can check the history. One moment.
[CUSTOMER][POSITIVE] Thank
[AGENT][NEUTRAL] OK, so it looks like the last pro fee was on, let's see, [PII].
[AGENT][NEUTRAL] The last oral evaluation was [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] mask.
[AGENT][NEUTRAL] OK, the last panel was on [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Oh it is
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, what else.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] And that's by wing, I see on [PII].
[CUSTOMER][NEUTRAL] Don't
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] And it looks like that's all that I see that may affect frequency.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] OK, that's it. Can you please verify your name and reference for this call?
[AGENT][NEUTRAL] My name is [PII]. That's [PII].
[CUSTOMER][NEUTRAL] OK, and the reference ID?
[AGENT][NEUTRAL] We don't have reference numbers. You can use my name in today's date if you if you like.
[AGENT][NEUTRAL] You need the spelling of my name?
[CUSTOMER][NEUTRAL] That's
[CUSTOMER][POSITIVE] Yeah, I already got it. Thank you for all the information. Have a great day. Bye.
[AGENT][NEUTRAL] You as well thank you for calling ATM. Mm bye bye, Mr. [PII].