AccountId: 011433970860
ContactId: 399215ec-10ab-48a9-bba3-aad8e5928560
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 498329 ms
Total Talk Time (AGENT): 186355 ms
Total Talk Time (CUSTOMER): 205447 ms
Interruptions: 0
Overall Sentiment: AGENT=0.9, CUSTOMER=0.9
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/21/399215ec-10ab-48a9-bba3-aad8e5928560_20250321T19:19_UTC.wav
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[AGENT][POSITIVE] Afternoon, thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi [PII]. Good day. By the way, my name is [PII]. My name is [PII], and I'm calling from the office of Doctor [PII]. How are you doing today?
[AGENT][NEUTRAL] I am doing fine and I do apologize, the phone was breaking up. Do you mind repeating your name?
[CUSTOMER][NEUTRAL] Sure, uh, my name again is [PII]
[AGENT][POSITIVE] Thank you, [PII]. And what is a good callback number?
[CUSTOMER][NEUTRAL] Yes, that's gonna be [PII].
[AGENT][POSITIVE] Thank you and how are you doing today?
[CUSTOMER][NEUTRAL] I'm doing fine, you know, waiting for the weekend.
[AGENT][NEUTRAL] Exactly, me too. And
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] How can I help you today?
[CUSTOMER][NEUTRAL] OK, well, uh, yes, by the way, [PII], uh, I need help in regards to my patients break down here.
[AGENT][NEUTRAL] I can help you with that. Yeah, what is the policy number for the patient?
[CUSTOMER][NEUTRAL] OK. Uh, yes, that's gonna be 02464467.
[AGENT][NEUTRAL] And the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Uh, this is for [PII] [PII].
[AGENT][POSITIVE] All right, thank you, and I can assist you with that breakdown today for [PII]. I am showing that her policy is active.
[AGENT][NEUTRAL] Effective date is [PII].
[CUSTOMER][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] And this is a limited dental policy. It does not cover major procedures, only covers preventive and basic procedures.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And I do have a breakdown. I can fax to you yeah with the calendar year max, deductibles, frequencies, limitations. It'll have our billing information, um, it will also have the frequencies and limitations and procedures listed that are covered. Would you like for me to fax that breakdown to you?
[CUSTOMER][NEUTRAL] Yeah, the
[CUSTOMER][NEUTRAL] Uh, you need to fax back. Uh-huh, yes, yes, I mean, it's really good to know, uh, that you guys have the fax back so that we can attach that one and our breakdown yet. Do you need, uh, my fax back number?
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Yes, who was that?
[CUSTOMER][NEUTRAL] Yes, that's gonna be [PII].
[AGENT][NEUTRAL] And just to verify that fax number is [PII]?
[CUSTOMER][POSITIVE] That is correct. Mhm.
[AGENT][NEUTRAL] All right, do I need to put that to your attention?
[CUSTOMER][NEUTRAL] Uh, you just put in. Yeah, yeah, you can.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] All right, and now the group name and number is not listed on the breakdown. I can provide that for you if needed.
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] The group number is.
[AGENT][NEUTRAL] 700.
[AGENT][NEUTRAL] 30
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] You need the group name?
[CUSTOMER][NEUTRAL] Yes, please.
[AGENT][NEUTRAL] The group name is Creative Circle.
[CUSTOMER][POSITIVE] Perfect.
[AGENT][NEUTRAL] And that breakdown is on the way for you.
[CUSTOMER][NEUTRAL] OK. All right, so.
[CUSTOMER][NEUTRAL] OK. Thank you so much. And by the way, I just wanted to confirm, uh, for the year, the max, is this still the same, $500?
[AGENT][NEUTRAL] It is.
[CUSTOMER][POSITIVE] OK, perfect. Nothing has been used?
[AGENT][NEUTRAL] For 2025, let me check that for you. Bear with me just a second.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And we will, uh, and we will be following till the Carrington fee schedule for E-network.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] I'm still getting that information, bear with me just one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] She has not used any of her benefits for [PII], nor met her deductible.
[CUSTOMER][NEUTRAL] OK, perfect. So, deductible uh for individual, I, I, I mean, that's $50 and then $150 for the family, right? And it only applies to basic, basic services only, or does it include the preventative?
[AGENT][NEUTRAL] Mhm.
[AGENT][POSITIVE] That's correct.
[AGENT][NEUTRAL] It only applies to basic services.
[CUSTOMER][NEUTRAL] OK. All right, thank you. So basically, major services are not covered and that includes the antidontics, peridontics, and the oral surgery.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And prosidonic repairs.
[CUSTOMER][NEUTRAL] Yes, yes, that's it. And um I just want to confirm that uh 0180, the comprehensive pay evaluation is not covered.
[AGENT][NEUTRAL] Can you repeat that code, please?
[CUSTOMER][NEUTRAL] Uh, D 0180. I just want to confirm it covered or not.
[AGENT][NEGATIVE] It is not covered.
[CUSTOMER][POSITIVE] And covered. OK. And also, um, no downgrade for the composites 2391 or the filling.
[AGENT][NEUTRAL] That's correct, we do not uh downgrade.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][NEUTRAL] Uh, so, surgical extraction, 7210 is not covered.
[AGENT][POSITIVE] That is correct.
[CUSTOMER][NEUTRAL] OK, perfect. Uh, by the way, is there any way you can provide me the histories or last date of service for diagnostic or preventative services only?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] I'm getting that pulled up now and we can look at that.
[AGENT][NEUTRAL] Preventive history. On 99-2024.
[AGENT][NEUTRAL] A pro fee
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] I'm sorry, on [PII], I'm sorry, the day the service is [PII].
[AGENT][NEUTRAL] Comprehensive or eva evaluation prophy and pano.
[AGENT][NEUTRAL] And bite wings.
[CUSTOMER][NEUTRAL] OK. I think that's gonna be the same history.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] That's all.
[CUSTOMER][NEUTRAL] Yeah, I guess that's, I mean, yeah, that's, that is actually on, on our record.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Here
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Uh-huh. OK. I think I'll just wait for the fax back, um, to be arrived here on our end so that I can attach this one on the breakdown. OK. So I think I'm good with this one, [PII]. Um, I think it was just your, uh, I mean, the reference number for this call. Would that be fine?
[AGENT][POSITIVE] The reference number is my name and today's date, and of course I spell my name [PII] first initial last name [PII], it was a pleasure to assist you with that breakdown today. If there's nothing else I can help you with, thank you for calling APL and have a wonderful weekend.
[CUSTOMER][POSITIVE] You as well. Thank you so much.
[AGENT][POSITIVE] Thank you. Bye-bye.