AccountId: 011433970860
ContactId: 3545bdcd-87aa-44ae-b900-787acf62ad85
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 834989 ms
Total Talk Time (AGENT): 156926 ms
Total Talk Time (CUSTOMER): 140574 ms
Interruptions: 0
Overall Sentiment: AGENT=1.5, CUSTOMER=-1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/02/10/3545bdcd-87aa-44ae-b900-787acf62ad85_20250210T15:14_UTC.wav
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[AGENT][NEUTRAL] Good morning. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hello, I'm calling to check um eligibility benefits and also see if we get networked with this insurance.
[AGENT][NEUTRAL] OK, sure, I can assist you with eligibility and network information and may I have your name?
[CUSTOMER][NEUTRAL] Yes, my name is [PII].
[AGENT][NEUTRAL] And may I have a callback number just in case we get disconnected, Miss [PII] and where are you calling from?
[CUSTOMER][NEUTRAL] Yes, [PII].
[CUSTOMER][NEUTRAL] Yes, [PII], um.
[CUSTOMER][NEUTRAL] Number is [PII].
[AGENT][NEUTRAL] And that's Texas Hospital, outpatient facility, clinic.
[CUSTOMER][NEUTRAL] Oh, OK. I didn't take your dental. I'm sorry, I thought you was asking the state.
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] It's OK, thank you.
[AGENT][NEUTRAL] OK, thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] Oh yes, 02300241.
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] Uh yes, name [PII], last name.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Date of birth is [PII].
[AGENT][NEUTRAL] Perfect, thank you. All right, and let's see, we have an effective date of [PII]. It is still active at the moment and this is a dental policy. Um, with this one, we do not have any networks. We pay you showing customary rates, UCR.
[AGENT][NEUTRAL] So they can choose to go to any dentist.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, OK, um, but will we still like we'll still just file with y'all though?
[AGENT][NEUTRAL] Mhm. Yes, yes.
[CUSTOMER][NEUTRAL] OK, OK, OK, um.
[CUSTOMER][NEUTRAL] OK, well let me get a breakdown for them. Um, can I get the maximum and deductible?
[AGENT][NEUTRAL] Um, sure. And this is not a guarantee of payment, just a verification of coverage and that's just a disclaimer. And we have a calendar year maximum of $1500 per cover insured with the $50 deductible and deductible does not apply to preventative.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Give me one second
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Thank
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] How
[CUSTOMER][NEUTRAL] OK, we only do those, yes, we do.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] For consultation
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yes ma'am
[CUSTOMER][NEUTRAL] Got the 24
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] OK, well you can just you can give us a call back so.
[CUSTOMER][NEUTRAL] There
[CUSTOMER][NEUTRAL] No
[CUSTOMER][POSITIVE] But that's why I said we'll, we will, we will schedule you because we got a new system.
[CUSTOMER][NEUTRAL] No, ma'am, that's why I say you have to get information.
[CUSTOMER][NEUTRAL] No
[CUSTOMER][NEUTRAL] I'm so sorry. OK, uh, OK, maximum is 1500 deductible. What did you say the deductible was?
[AGENT][NEUTRAL] 50.
[AGENT][NEGATIVE] And deductibles do not apply to preventatives.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] But it applied to basic and major.
[AGENT][POSITIVE] Yes, mhm, correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, what is the percentages for preventive basic and major?
[AGENT][NEUTRAL] OK, so preventative is cover 100%.
[AGENT][NEUTRAL] Um, radiograph FMX is covered at 80%. Basic expense and basic restorative expense is 80%, and then we have major service including endoonic periodontics, prosthodontic repair and or surgery, they're all 40%.
[CUSTOMER][NEUTRAL] Mm. And you said that's endo and oral surgery?
[AGENT][NEUTRAL] Including in the periodontics and neurosurgery.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And is it crown and bridges covered also?
[AGENT][NEUTRAL] Yes, that's also under the major service. Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][POSITIVE] OK, and that's 40% correct.
[AGENT][POSITIVE] Correct. Mhm.
[CUSTOMER][NEUTRAL] OK, um, any waiting period?
[AGENT][NEUTRAL] Um, not for this one. This one is out of the waiting period. Um, the effective date was [PII] and there was a 12 month waiting period. It went up, it went up on the [PII].
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] OK, on crown and bridges, do you pay on C date or prep date?
[AGENT][NEUTRAL] I see.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And I got one code is D 1206 and D 4921 covered.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] 1206 is not covered. Let, let me check for 921. OK, one moment.
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] 4921 is not covered.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, and do I do fax packs?
[AGENT][NEUTRAL] We do. Mhm. Do you need a fax back of the benefits?
[CUSTOMER][NEUTRAL] OK, yes ma'am.
[AGENT][NEUTRAL] OK what is the tax number.
[CUSTOMER][NEUTRAL] 903-758.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] 3862.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Do you mind holding for me while I send this out to you I got you on the line, Miss [PII].
[CUSTOMER][NEUTRAL] Uh huh uh huh.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[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][POSITIVE] Thank you for holding and being patient for me. Yeah, I went ahead and send that over to you. You should be there in a few minutes. Is there anything else I can help you with today?
[CUSTOMER][NEUTRAL] Uh, no, I think that'll be all.
[AGENT][POSITIVE] Thank you. Thank you for calling APL. Have a good day, Miss [PII].
[CUSTOMER][POSITIVE] You too have a great day bye bye.
[AGENT][POSITIVE] Thank you. Bye bye.