AccountId: 011433970860
ContactId: 48a38e56-c708-4cc3-ba9c-1c67b72d0596
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 308209 ms
Total Talk Time (AGENT): 87053 ms
Total Talk Time (CUSTOMER): 120682 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=0.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/11/48a38e56-c708-4cc3-ba9c-1c67b72d0596_20250411T16:55_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, good afternoon, [PII]. I was just on a call with another rep, but it looks like the call dropped. Um, I was looking for benefits of [PII].
[CUSTOMER][NEUTRAL] Um, I have the member ID for his dental coverage.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Can I get your name and a good callback number?
[CUSTOMER][NEUTRAL] Name is [PII]. Telephone number to call me back is [PII].
[AGENT][NEUTRAL] And the policy number of the patient?
[CUSTOMER][NEUTRAL] Uh, the name is [PII].
[AGENT][NEUTRAL] OK, you don't have the
[CUSTOMER][NEUTRAL] And the member ID is 02.
[AGENT][NEUTRAL] OK, go ahead.
[CUSTOMER][NEUTRAL] The what? I'm sorry.
[AGENT][NEUTRAL] I was just asking for the member ID.
[CUSTOMER][NEUTRAL] The member ID is 0.
[CUSTOMER][NEUTRAL] Oh yeah, so it's 02486464.
[AGENT][NEUTRAL] And the date of birth.
[CUSTOMER][NEUTRAL] Date of birth for the patient would be.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK, it looks like his policy, let me see.
[AGENT][NEUTRAL] Policy is effective [PII] currently active. And then I can send a fax back that outlines all of the plan coverage, or is there, do you want to go over anything on the phone?
[CUSTOMER][NEUTRAL] This is
[CUSTOMER][NEUTRAL] Yeah, if I could get the fax of the breakdown, but now right that I have you on the phone, um, can I get the policy name?
[AGENT][NEUTRAL] Uh, policy name is or I'm sorry, D4.
[AGENT][NEUTRAL] FF
[AGENT][NEUTRAL] S U T
[AGENT][NEUTRAL] BA.
[CUSTOMER][NEUTRAL] So I'm gonna go ahead and say it right back to you. The policy name, um, D as in dog 4 F as in Frank, F as in Frank, S as in Sam, U as in umbrella, T as in Tom, B as in ball, A as in apple.
[AGENT][POSITIVE] Yes, that's right.
[CUSTOMER][NEUTRAL] OK, and what is his max?
[AGENT][NEGATIVE] Um, this is not OK, not a guarantee of payment, basic outline of the policy. Uh, annual maximum benefit is 1500 per calendar year.
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And does he have a deductible?
[AGENT][NEUTRAL] A deductible is $50 which applies to basic, um, and major expenses.
[CUSTOMER][NEUTRAL] And he has his full 1500 remaining, correct?
[AGENT][NEUTRAL] Uh, let's see.
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] 693
[AGENT][NEUTRAL] Uh, yes, he does.
[CUSTOMER][NEUTRAL] OK, um, and what the schedule would we be using?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] So this just it we don't have a specific fee schedule it's just gonna pay what's reasonable and customary.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, are you able to, well, so you don't, so you're not able to see if we're an in network provider?
[AGENT][NEUTRAL] There's no network. He can see anyone he likes.
[CUSTOMER][NEUTRAL] Oh, anyone, OK.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] No.
[CUSTOMER][NEUTRAL] And where the claims will be sent off to hold on let me make sure [PII].
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] As long as we send it to there, we should receive some type of payment for his visit.
[AGENT][NEUTRAL] Yes, as long as it's an eligible expense and he's still active when we receive it.
[CUSTOMER][POSITIVE] OK, alrighty, well, I'll just be, uh, if you could please just send me the fax, that would be great.
[AGENT][NEUTRAL] OK, what's your facts?
[CUSTOMER][NEUTRAL] 919-693
[CUSTOMER][NEUTRAL] 9067
[AGENT][NEUTRAL] OK, [PII], I'll get that sent over to you. Just give me about 2 minutes.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] OK, thank you for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] Mm bye bye.