AccountId: 011433970860
ContactId: 3caf07be-66b0-483e-a4cb-a6f4bd1a1605
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 436869 ms
Total Talk Time (AGENT): 173592 ms
Total Talk Time (CUSTOMER): 172015 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/04/3caf07be-66b0-483e-a4cb-a6f4bd1a1605_20250304T16:29_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Um, good morning. I'm calling for a breakdown of benefits, please.
[AGENT][NEUTRAL] OK. I can verify benefits.
[CUSTOMER][NEUTRAL] Oh, to see if we are providers, pardon.
[AGENT][NEUTRAL] OK, I can verify benefits for you and your name is?
[CUSTOMER][NEUTRAL] OK, just.
[AGENT][NEUTRAL] I'm sorry, say again.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] Uh, spell your name for me, please.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] OK, thank you. And what is the policy number, please?
[CUSTOMER][NEUTRAL] Policy number is 002596141.
[AGENT][NEUTRAL] OK, thank you. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] Sure, [PII].
[AGENT][NEUTRAL] OK, thank you. And let's see, Ms. A verify the patient's name, date of birth.
[CUSTOMER][NEUTRAL] Patient's name, first name is [PII]
[CUSTOMER][NEUTRAL] Do you want the date of birth?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, and you say you're calling to verify benefits for dental?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And to and to verify that we are providers for that particular plan.
[AGENT][NEUTRAL] Well, we don't have a network of providers. Uh, this policy is open and it pays by UCR.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][NEUTRAL] OK, UCR.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and if you like, uh, you need a general breakdown or I can send you a fax back?
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Can I do both?
[AGENT][NEUTRAL] Sure. Uh, what's your fax number so I can get that started?
[CUSTOMER][NEUTRAL] Just
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Um
[AGENT][NEUTRAL] OK, I just need general, uh, not a guarantee of payment, just a verification of coverage. The patient has a benefit max up to $500 per calendar year, and they have a $50.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 2
[AGENT][NEUTRAL] 500, that's the benefit max per calendar year.
[CUSTOMER][NEUTRAL] Just, just 500.
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Uh, they have a $50 deductible that applies to everything but preventative services.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, preventative pay 100% of UCR.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Basic, basic restorative FMX panoramic pays at 80 and under this policy, major services are not covered and that would include endo perio and oral surgery, as well as crowns, bridges, partials, and dentures.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Bridges, partials, and dentures also.
[AGENT][NEUTRAL] Yes, ma'am, that they are considered major and which is not covered. Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Any waiting periods?
[AGENT][NEUTRAL] Uh, there's no waiting period and there is a missing tooth clause.
[CUSTOMER][NEUTRAL] There is.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEGATIVE] Uh no.
[CUSTOMER][NEUTRAL] Let me see, any implant, OK, is the coverage for um.
[CUSTOMER][NEUTRAL] Fortnite guards.
[AGENT][NEUTRAL] No, ma'am, that is considered major, so it's not covered.
[CUSTOMER][NEUTRAL] Oh, OK, is the downgrade for um.
[CUSTOMER][NEUTRAL] For fillings.
[AGENT][NEUTRAL] Uh, there's no downgrades.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, has any of the maximum been used?
[AGENT][NEUTRAL] Uh, no, she hasn't used any benefits nor met her deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK, when did she become effective?
[AGENT][NEUTRAL] Uh, [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Trying to see is there um.
[CUSTOMER][NEUTRAL] What's the frequencies for profies?
[AGENT][NEUTRAL] Uh, cleanings are once every 6 months.
[CUSTOMER][NEUTRAL] Consecutive or?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] OK, what about um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] FMS Forma series and panel.
[AGENT][NEUTRAL] Uh, FMX and Panos are once every 5 years, and they do share frequency.
[CUSTOMER][NEUTRAL] OK sure.
[CUSTOMER][NEUTRAL] OK, um, pero, 01 moment.
[CUSTOMER][NEUTRAL] Full mouth debridement is that that's.
[AGENT][NEUTRAL] That falls on a periodontics, which is not covered, nor is a per maintenance.
[CUSTOMER][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] OK, what's the mailing address, please?
[AGENT][NEUTRAL] Uh, it's [PII].
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Um, say the, the zip again please.
[AGENT][NEUTRAL] I'm sorry, [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][POSITIVE] OK thank you and your name again please?
[AGENT][NEUTRAL] Uh, it's [PII], last initial [PII] I just sent that fax back, so hopefully you should receive it in a few moments.
[CUSTOMER][NEUTRAL] Oh
[CUSTOMER][POSITIVE] OK, thank you so much.
[AGENT][POSITIVE] Oh, you're welcome. And is there anything else I can assist you with today?
[CUSTOMER][POSITIVE] Um, no, no thanks. The fax is coming through. I can hear it. Thank you so much.
[AGENT][POSITIVE] Oh, you're welcome. Thank you for calling APL. Have a great day.
[CUSTOMER][POSITIVE] Thanks you too bye bye.
[AGENT][NEUTRAL] Bye.