AccountId: 011433970860
ContactId: 3ff7bafc-7637-448e-95c0-6aa3925453ab
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 289559 ms
Total Talk Time (AGENT): 116743 ms
Total Talk Time (CUSTOMER): 145123 ms
Interruptions: 7
Overall Sentiment: AGENT=0.3, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/06/3ff7bafc-7637-448e-95c0-6aa3925453ab_20250606T18:49_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. May I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, my name is [PII] and I'm calling from dental provider office. I'm checking up on eligibility and benefits. Can you help me out?
[AGENT][NEUTRAL] Sure, I can verify benefits and eligibility for you. And [PII], what is the policy number, please?
[CUSTOMER][NEUTRAL] And.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Oh yeah. It's 02564654.
[AGENT][NEUTRAL] OK, thank you. Give me a moment. And do you have a callback number in case the call drops?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh yes, ma'am. It's [PII] and it's a direct line.
[AGENT][NEUTRAL] OK, and the patient's name, date of birth?
[CUSTOMER][NEUTRAL] That's what I.
[CUSTOMER][NEUTRAL] The patient's full name is [PII]. Date of birth is [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, showing her effective date is [PII]. She is active on the policy, and on any general breakdown of benefits or I can send you a fax back.
[CUSTOMER][NEUTRAL] 47
[CUSTOMER][NEUTRAL] 461.
[CUSTOMER][NEUTRAL] OK, can you just help me with the general breakdown for this patient?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][NEUTRAL] is
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Not a guarantee of payment, just verification coverage. Patient has a benefit max up to $500 per calendar year, and they have a $50 deductible that applies to everything but preventative services.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] are important.
[CUSTOMER][NEUTRAL] 12
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Major services are not covered under this policy. Preventative pays 100% of UCR.
[CUSTOMER][NEUTRAL] right.
[CUSTOMER][NEUTRAL] and also um.
[AGENT][NEUTRAL] Uh, basic, basic restorative FMX panoramic pays at.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 00
[AGENT][NEUTRAL] 80%.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK, what other information are you needing?
[CUSTOMER][NEUTRAL] Uh, yeah, like from the deductive and an annual maximum, anything use anything met?
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Uh, shows so far she's only or she has remaining for this year $53.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] And she has met her deductible.
[CUSTOMER][POSITIVE] From the $500 just, thank you so much. Uh, so sorry for breaking you. From the 500, just $53 is remaining.
[AGENT][NEUTRAL] Yes.
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK. Thank you. And it's a dental PPO plan?
[AGENT][NEUTRAL] Is it a what?
[CUSTOMER][NEUTRAL] A dental PPO plan?
[AGENT][NEUTRAL] Well, we don't have any preferred providers. The policy is open to where they can go to any dental provider.
[CUSTOMER][NEUTRAL] Any dental provider. OK. And what will be the group number and group name?
[AGENT][NEUTRAL] Uh, let's see, group number one moment.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] 70,030. Group name is Creative Circle.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh coordination of benefit. Is it standard or non-duplicating?
[AGENT][NEUTRAL] Standard
[CUSTOMER][NEUTRAL] Oh what is this?
[CUSTOMER][NEUTRAL] Standard. And is orthodontic covered under this plan?
[AGENT][NEUTRAL] No, the policy doesn't cover any major services.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, and one last, uh, is there any history on file which might affect the frequency?
[AGENT][NEUTRAL] Let me one moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Uh, externalized cleaning, exam, and
[CUSTOMER][NEUTRAL] Oh
[AGENT][NEUTRAL] The full mouth we're all on 513 to 25.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] And for the cleaning, the procedure code is 0120.
[AGENT][NEUTRAL] Well, any cleanings, um, or for preventative, once every 6 months.
[CUSTOMER][NEUTRAL] OK. And um yup, uh just one last, uh, is pre-authorization mandatory?
[AGENT][NEUTRAL] No.
[CUSTOMER][POSITIVE] OK, then that's all. Thank you so much. Can you please spell out your name and can you please provide me the card reference number?
[AGENT][NEUTRAL] Uh, call reference is my name it's a state and it's [PII] last initial Q as in Quebec.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Oh.
[CUSTOMER][POSITIVE] Thank you so much, thank you for helping me out and have a great day. Bye-bye. Take care. Happy weekend.
[AGENT][POSITIVE] Mhm. You too. Thanks for calling APL. Bye.