AccountId: 011433970860
ContactId: 30725868-9cdd-4aa1-af31-26666aa499e7
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 884099 ms
Total Talk Time (AGENT): 253348 ms
Total Talk Time (CUSTOMER): 203704 ms
Interruptions: 0
Overall Sentiment: AGENT=1.1, CUSTOMER=-0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/22/30725868-9cdd-4aa1-af31-26666aa499e7_20250422T16:35_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Good morning, [PII]. My name is [PII]. I am calling from Davis Dentistry. I need to verify a family that we have here in the office, uh, for insurance, please.
[AGENT][NEUTRAL] OK, I can um give you eligibility on a policy for a family, Ms. [PII]. May I please get your callback number just in case our call is disconnected?
[CUSTOMER][NEUTRAL] Uh yes, ma'am. It's [PII].
[CUSTOMER][NEUTRAL] [PII] no extension.
[AGENT][NEUTRAL] Thank you ma'am. And then what is the name of the facility you're calling from?
[CUSTOMER][NEUTRAL] It is Davis Dentistry.
[AGENT][NEUTRAL] With Davis Dental?
[AGENT][POSITIVE] Oh, dentistry. OK, thank you so much.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, that.
[AGENT][NEUTRAL] And then may I get the.
[AGENT][NEUTRAL] Uh
[AGENT][NEUTRAL] Policyholder's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] Yes, ma'am. The policy number would be 02.
[CUSTOMER][NEUTRAL] 609-900.
[CUSTOMER][NEUTRAL] The name would be [PII].
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][POSITIVE] Thank you very much and let me look up that policy real quick.
[AGENT][NEUTRAL] OK, and you wanted to check on the whole family, is that correct?
[CUSTOMER][NEUTRAL] Uh, correct, um, which is [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII] and [PII].
[AGENT][POSITIVE] Yes, I do show that the family is active.
[AGENT][NEUTRAL] Um, the policy is active and current and their effective date is [PII].
[CUSTOMER][POSITIVE] Perfect. Do you guys do backpacks?
[AGENT][NEUTRAL] Yes ma'am, if you can give me your fax number I'll send you a fax back for this policy.
[CUSTOMER][NEUTRAL] Uh yes. It's [PII].
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, I'm gonna put you on a brief hold while I get that fax ready for you and I'll be right back with you, Miss [PII].
[CUSTOMER][POSITIVE] Perfect. Thank you.
[AGENT][POSITIVE] Thank you, ma'am.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Thank you for holding Miss [PII]. It appears I'm having a little bit of trouble with my fax right now, um, but I have not, uh, sent it yet. I do have it in line to send and I will make sure that it gets to you, but I just wanted to let you know that I'm having a little bit of issues with my fax at the moment.
[CUSTOMER][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK, um, but it will be sent, correct?
[AGENT][NEUTRAL] Yes, I will on it until I get it sent to you.
[CUSTOMER][NEUTRAL] OK, perfect. Can you just confirm a couple of things uh for me, please, for the policy?
[AGENT][POSITIVE] Sure, yes ma'am.
[CUSTOMER][NEUTRAL] Just cause the patient is in the office right now.
[AGENT][NEUTRAL] Oh, OK, OK, yes ma'am.
[CUSTOMER][NEUTRAL] OK, um, uh, do you have her annual max and deductibles?
[AGENT][NEUTRAL] Yes, and this is just to verify her benefits. It's not a guarantee of payment. She has an annual calendar year maximum benefit of $500 per covered insured, and she has a calendar year deductible of $50 per covered insured up to $150 for family.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Is there any waiting period?
[AGENT][NEUTRAL] No, ma'am.
[CUSTOMER][NEUTRAL] No waiting period?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, perfect. Um, what would be your percentages for uh preventative, basic, and major?
[AGENT][NEUTRAL] OK, she has, she has 100% of allowable for preventative.
[AGENT][NEGATIVE] 80% of allowable for basic and this policy does not cover major.
[CUSTOMER][NEUTRAL] OK, so no major.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] What would be, what would fall under major? Is it only crowns and plants?
[CUSTOMER][NEUTRAL] Bridges or um is, does that include indo and Perio?
[AGENT][NEUTRAL] Uh, can you give me the code that you need me to look up, um.
[AGENT][NEUTRAL] And I'll look and see if it's on the fax back if it's on here it's covered if it's not on here then it's a non covered procedure um what is the code for the crown?
[CUSTOMER][NEUTRAL] Oh, for the crowns, uh, 2510.
[AGENT][NEUTRAL] OK let me look and see real quick if I've got that on here.
[AGENT][NEUTRAL] No, ma'am, that is not a covered procedure.
[CUSTOMER][NEUTRAL] So no rows, OK.
[CUSTOMER][NEUTRAL] Uh, what about
[AGENT][NEUTRAL] It has basic restorative on this policy, but not any major.
[CUSTOMER][NEUTRAL] OK, so restorative, uh, which is fillings, so that's the only basic coverage.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Uh, what about uh 30 to 20?
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] No, ma'am. That's a non-covered procedure.
[CUSTOMER][NEUTRAL] OK, so no endo as well.
[CUSTOMER][NEUTRAL] Uh, what about 3330?
[AGENT][NEUTRAL] Let me check.
[AGENT][NEUTRAL] No, no, 3330.
[CUSTOMER][NEUTRAL] OK, so no and do. Uh, what about 4341?
[AGENT][NEGATIVE] No ma'am, that's not covered.
[CUSTOMER][NEUTRAL] OK. So, no pero as well. 4346?
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] I do not see 4346.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 4910.
[AGENT][NEUTRAL] No, 4910.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Oral surgery, which is 7140.
[AGENT][NEUTRAL] No ma'am that's not on this policy.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, so she only has cleaning and restorative, which is fillings. Can you just confirm if uh X-rays, if they fall under basic or preventative? 0 3:30?
[AGENT][NEUTRAL] Right.
[AGENT][NEUTRAL] Yes ma'am, I'm
[AGENT][NEUTRAL] 0330 is under.
[AGENT][NEUTRAL] Radio FMX.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] So that would be preventative or basic?
[AGENT][NEUTRAL] It looks like um let's see FMX is going to be.
[AGENT][NEUTRAL] It's 80% of the allowable under radiographs. It's not under basic or preventative. It has its own radiographs, FMX expenses is 80% of allowable.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, what about bit wings, 0 to 70?
[AGENT][NEUTRAL] A bite wings are once every twelve-month period.
[CUSTOMER][NEUTRAL] And 12 months.
[CUSTOMER][POSITIVE] OK, perfect. Uh.
[CUSTOMER][NEUTRAL] What about PA's, uh, which is 0 to 20?
[AGENT][NEUTRAL] OK, let me look.
[AGENT][NEUTRAL] Yes, that falls under uh basic.
[CUSTOMER][NEUTRAL] Basic? OK.
[CUSTOMER][NEUTRAL] And is there an age limit for that? I mean, uh, uh, frequency?
[AGENT][NEUTRAL] Let me see, that is first film.
[AGENT][NEUTRAL] That is once every 5 years full mouth X-rays and panoramics are once every 5 years.
[CUSTOMER][POSITIVE] OK, perfect. OK, thank you so much. I'll wait on that fax. Um, I'll let the patient know that.
[AGENT][POSITIVE] Yes ma'am, I'm gonna.
[AGENT][POSITIVE] OK alright and uh in the meantime I'm gonna be working on this and getting some help to get it.
[AGENT][NEUTRAL] Back to where it should be again.
[AGENT][POSITIVE] And then I'll send it just as soon as as soon as I get it up and running again, OK?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK perfect thank you so much for your help.
[AGENT][POSITIVE] You're very welcome. I hope you have a wonderful day. Is there anything else I can help you with before we go?
[CUSTOMER][NEUTRAL] Um, no, that is it.
[AGENT][POSITIVE] OK, well, you have a good day, Ms. [PII], and thank you for calling APL.
[CUSTOMER][POSITIVE] Thank you. You too.
[AGENT][NEUTRAL] All right, bye bye, ma'am.
[CUSTOMER][NEUTRAL] Uh.