AccountId: 011433970860
ContactId: 3b6d5329-1138-4f20-aef9-4eb7ec3b95b4
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 550859 ms
Total Talk Time (AGENT): 119025 ms
Total Talk Time (CUSTOMER): 152008 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/2025/06/16/3b6d5329-1138-4f20-aef9-4eb7ec3b95b4_20250616T18:59_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] speaking. And could you assist me with the dental benefits and the eligibility of the patient?
[AGENT][POSITIVE] Yes, I can help with benefits and eligibility. [PII], do you have a good callback number?
[CUSTOMER][NEUTRAL] Yes, of course, it's [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And policy number for the patient?
[CUSTOMER][NEUTRAL] Yes. The policy number, it could be just a moment.
[CUSTOMER][NEUTRAL] It's A as in Alpha, B as in boy, 10,220 for the ticket.
[AGENT][NEUTRAL] Um, that's not one of our policy numbers. Do you have a last name?
[CUSTOMER][NEUTRAL] Yes, it's [PII].
[AGENT][NEUTRAL] And first name?
[CUSTOMER][NEUTRAL] Have you
[CUSTOMER][NEUTRAL] OK. First name, it is.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, you have the patient's date of birth?
[CUSTOMER][NEUTRAL] Yes, of course. Patient date of birth [PII].
[AGENT][NEUTRAL] Uh, policy is active and effective [PII].
[AGENT][NEUTRAL] And then I can
[CUSTOMER][NEUTRAL] OK, [PII]. Go ahead.
[AGENT][NEUTRAL] I can send a fax back that outlines all the policy codes that are covered with the reimbursement amounts.
[AGENT][NEUTRAL] Do you need me to send that or is there something you need to go over on the phone?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, I have just some specific questions only for this patient before you send me fax. May I know the network benefits, annual max and deductibles?
[AGENT][NEUTRAL] This is not a guarantee of payment. Basic outline of the policy.
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] Uh, annual maximum benefit is 1000.
[AGENT][NEUTRAL] And you say, I'm sorry, what else did you say?
[CUSTOMER][MIXED] OK, deductibles.
[AGENT][NEUTRAL] Deductible. Hold on just a second.
[AGENT][NEUTRAL] OK, um, deductible is $50.
[AGENT][NEUTRAL] Does not apply to exams or profi.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Family deductibles.
[AGENT][NEUTRAL] 150.
[CUSTOMER][NEUTRAL] And the co-insurance for the you to basic and nature.
[AGENT][NEUTRAL] There's no coinsurance, it's a fee schedule.
[CUSTOMER][NEUTRAL] No insurance. OK. Is there any group number and a group name?
[AGENT][NEUTRAL] Uh, that is.
[AGENT][NEUTRAL] Um, there's no group name.
[CUSTOMER][NEGATIVE] And there is no group name and uh uh the group number is not there, it's not available.
[AGENT][NEUTRAL] Correct. No group number, no.
[CUSTOMER][NEUTRAL] And no coinsurance as well.
[AGENT][NEUTRAL] No, it just pays a specific dollar amount for coach.
[CUSTOMER][NEUTRAL] OK. It is a co-pay type of plan.
[AGENT][NEUTRAL] Yes, it's a fee schedule plan, yeah.
[CUSTOMER][NEUTRAL] OK. May I know the patient is policy holder?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] The patient is the policyholder.
[AGENT][NEUTRAL] No, she's not. She's the spouse.
[CUSTOMER][POSITIVE] OK, thank you for confirming that one.
[CUSTOMER][NEUTRAL] And just give me a moment, please.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] Uh, the, could you please confirm the patient ID? Is it [PII]? That's the correct ID, correct?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Let me confirm the policyholder as well. Just a second.
[CUSTOMER][NEUTRAL] And the policyholder name is [PII], [PII]. Is that correct?
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][POSITIVE] OK, thank you for that confirmation and.
[CUSTOMER][NEUTRAL] Is there any huge amount from the annual maximum deductibles?
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] Uh, no, nothing's been used in [PII].
[CUSTOMER][NEUTRAL] OK. Is there any orthodontic benefits?
[AGENT][NEUTRAL] Um, let's see.
[AGENT][NEUTRAL] No, there's no ortho.
[CUSTOMER][NEUTRAL] OK. And is there any dental care which is affected by the frequency?
[AGENT][NEUTRAL] Um, but I'd have to look it up by code, which codes are you wanting to check on?
[CUSTOMER][NEUTRAL] OK, starting with D 0150.
[AGENT][NEUTRAL] Yeah, I don't have that code on file that they've used it. What was the next one?
[CUSTOMER][NEUTRAL] OK. E 0 120.
[AGENT][NEUTRAL] Uh, I don't show that code on file.
[CUSTOMER][NEUTRAL] OK, this is a 140.
[AGENT][NEUTRAL] Uh, nothing on file.
[CUSTOMER][NEUTRAL] OK. D 1110.
[AGENT][NEUTRAL] Uh I don't show that.
[CUSTOMER][NEUTRAL] OK. 0210.
[AGENT][NEUTRAL] I'm not showing that.
[CUSTOMER][NEUTRAL] 0330.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] I don't show that.
[CUSTOMER][NEUTRAL] OK. 0274.
[AGENT][NEUTRAL] I don't show that either.
[CUSTOMER][NEUTRAL] 4910.
[AGENT][NEUTRAL] I don't show that.
[CUSTOMER][NEUTRAL] 2740.
[AGENT][NEUTRAL] Don't show that.
[CUSTOMER][NEUTRAL] 2950 this one?
[AGENT][NEUTRAL] I don't show that on file.
[CUSTOMER][NEUTRAL] OK. Last code 4341.
[AGENT][NEUTRAL] Don't show that on file.
[CUSTOMER][NEUTRAL] OK, that's all. And
[CUSTOMER][NEUTRAL] I have the call number. Could you spell out your name?
[AGENT][NEUTRAL] Call reference number is my name is [PII]. It's [PII].
[AGENT][NEUTRAL] First initial to last name, [PII], and then today's date with my name as the reference.
[CUSTOMER][POSITIVE] OK, thank you so much and have a nice day. Take care. That's all for today.
[AGENT][POSITIVE] Thanks for calling APL. You as well. Bye-bye.