AccountId: 011433970860
ContactId: 35c55776-8d97-47c0-acf5-eb7bafd67e60
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 707539 ms
Total Talk Time (AGENT): 166821 ms
Total Talk Time (CUSTOMER): 167607 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.2
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/05/28/35c55776-8d97-47c0-acf5-eb7bafd67e60_20250528T13:42_UTC.wav
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[AGENT][NEUTRAL] APL, this is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from Prada So Dental Benefits.
[AGENT][NEUTRAL] I'm sorry, what was that?
[CUSTOMER][NEUTRAL] This is [PII].
[AGENT][NEUTRAL] OK, and what can I help you with today?
[CUSTOMER][NEUTRAL] Calling for dental benefits.
[AGENT][POSITIVE] OK, I can help you with dental benefits. Can I get a good callback number in case we get disconnected?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] And do you have the policy number?
[CUSTOMER][NEUTRAL] Policy number is 00603408.
[AGENT][NEUTRAL] Alright, one moment while I look that up.
[AGENT][NEUTRAL] Can I get you to verify the patient's name and date of birth?
[CUSTOMER][NEUTRAL] come here.
[CUSTOMER][NEUTRAL] Patient's name [PII]. Date of birth is [PII].
[AGENT][POSITIVE] Thank you so much.
[CUSTOMER][NEUTRAL] I think
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And are you wanting a fax back of everything that's in.
[AGENT][NEUTRAL] Included in their policy?
[CUSTOMER][NEUTRAL] Um, we have verified this patient before in the year [PII]. Is it the same benefits for both here?
[CUSTOMER][NEUTRAL] I mean from is it the same benefits from last year?
[AGENT][NEUTRAL] From [PII]?
[AGENT][NEUTRAL] Yes, it should be. This policy has been active since [PII] I'm sorry, [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And it looks like it should be the same one.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So this is based on free schedule active from [PII].
[CUSTOMER][NEUTRAL] Group name, Department of Social Services, group number LA 0144.
[AGENT][NEUTRAL] Let me check on that.
[AGENT][POSITIVE] Yes ma'am, that is correct.
[CUSTOMER][NEUTRAL] OK, and annual maximum $1000 deductible $50 no family deductible?
[AGENT][NEUTRAL] Let me check on that real quick.
[AGENT][NEUTRAL] Deductible $50.
[AGENT][NEUTRAL] And calendar year maximum 1000, yes ma'am.
[CUSTOMER][NEUTRAL] What
[CUSTOMER][NEUTRAL] OK, so deductive applies to all services including preventive and diagnostic.
[CUSTOMER][NEUTRAL] Policy is based on fee schedule and not in percentage. There's no implant and no or coverage.
[CUSTOMER][NEUTRAL] Is that right?
[AGENT][NEUTRAL] Let me check.
[AGENT][NEUTRAL] I'm just gonna double check real quick.
[CUSTOMER][NEUTRAL] Why
[AGENT][NEUTRAL] Give me just a moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, it is on a fee schedule.
[CUSTOMER][NEUTRAL] OK. And uh I have there's no waiting period. There is an essential clause. crowns are they don't either prep or sedate replacement period for crowns, and dentures are one every 5 years, no coverage for implants and bridges. Is that right?
[AGENT][NEUTRAL] Let me see.
[AGENT][NEUTRAL] Right, I'm not seeing any implants. Oh, there is bridge. Let me check.
[AGENT][NEUTRAL] Right, I'm seeing fixed bridge but not to get bridges you're correct.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] I have code 6740 if you can check with code.
[AGENT][NEUTRAL] 6740.
[AGENT][NEUTRAL] I'm not seeing code 6740.
[CUSTOMER][POSITIVE] OK, no worries. And uh I have like a few codes. It's uh 6 codes to verify for frequency and uh free schedule amount if you can help me out with that.
[AGENT][NEUTRAL] OK. What's the first code?
[CUSTOMER][NEUTRAL] Um, it's 573 0.
[AGENT][NEUTRAL] Give me one moment.
[AGENT][NEUTRAL] I have benefit amount $64.
[CUSTOMER][NEUTRAL] No frequency?
[AGENT][NEUTRAL] Let's see, that's a removal, that's a removal.
[CUSTOMER][NEUTRAL] OK. 5731.
[AGENT][NEUTRAL] 57 or 67?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] 573 1
[AGENT][NEUTRAL] OK. I have a benefit amount of $55.
[CUSTOMER][NEUTRAL] OK. 55.
[CUSTOMER][NEUTRAL] 7953
[AGENT][NEUTRAL] Give me one moment.
[AGENT][NEUTRAL] I'm not seeing that one.
[CUSTOMER][NEUTRAL] 42. OK, no worries, no 42 60 0350.
[AGENT][NEUTRAL] Let me check.
[AGENT][NEUTRAL] I'm not seeing that one either.
[CUSTOMER][NEUTRAL] 1330.
[AGENT][NEUTRAL] I'm not seeing that one either.
[CUSTOMER][NEUTRAL] And the last code is 9944.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] 9944.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I'm not seeing that one either.
[CUSTOMER][NEUTRAL] OK. Um, any history for the patient after [PII]?
[AGENT][NEUTRAL] Could you repeat that, please?
[CUSTOMER][NEUTRAL] Uh, do you have any history for the patient after [PII]?
[AGENT][NEUTRAL] Let me check.
[AGENT][NEUTRAL] I'm showing he used some benefits in [PII].
[AGENT][NEUTRAL] I can't see what those benefits are.
[AGENT][NEUTRAL] But he did use some benefits in [PII] and none for [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, can you please give me the history for the patient after [PII]?
[AGENT][NEUTRAL] I'm not able to see that. All I'm able to see is one.
[AGENT][NEUTRAL] Um, how much he used during the year and so for [PII] he used $95.
[AGENT][NEUTRAL] That's all I'm able to see.
[CUSTOMER][NEUTRAL] OK. So you
[CUSTOMER][NEUTRAL] No codes, uh, I mean, you can't see any codes or data services.
[AGENT][NEUTRAL] Right, not for this one, let me check.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] Right. We would need to see their doctor. The doctor would need to give you that information or the patient would.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] No worries. Your claim will be person pay ID.
[AGENT][NEUTRAL] Our payer ID?
[CUSTOMER][NEUTRAL] Yeah, mailing address and pay ID.
[AGENT][NEUTRAL] OK, mailing address is [PII].
[AGENT][NEUTRAL] In [PII].
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] And our payer ID is 60801.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Your name and a reference number.
[AGENT][NEUTRAL] My name is [PII], last initial [PII], and for a reference number, you can use my name and last initial in today's date.
[CUSTOMER][POSITIVE] Thank you. Have a good day, [PII].
[AGENT][NEUTRAL] OK.
[AGENT][POSITIVE] Thank you for calling APL. Have a great day.