AccountId: 011433970860
ContactId: 491cd360-55d3-45cd-be5c-c88f5effd1d0
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 274010 ms
Total Talk Time (AGENT): 107541 ms
Total Talk Time (CUSTOMER): 62166 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=1.3
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/31/491cd360-55d3-45cd-be5c-c88f5effd1d0_20250131T15:11_UTC.wav
--------------------------------------------
[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, this is [PII] calling from Forward Dental West Dallas. I was just calling to check if patients still had coverage.
[AGENT][NEUTRAL] OK, [PII], you're not needing a fax back of benefits. You only need to verify if the policy is still active.
[CUSTOMER][POSITIVE] Yes, that's correct.
[AGENT][POSITIVE] OK. Yes, ma'am. I can help you with that. And what is a good callback number for you, please?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you. And the member's policy number, please, [PII].
[CUSTOMER][NEUTRAL] 02097908.
[AGENT][NEUTRAL] OK, thank you. One moment, please.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And any information, [PII] that I do provide for you will be a verification of benefits and not a guarantee of payment. What is your patient's name, please, and their date of birth?
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um, my strike and it's [PII].
[AGENT][NEUTRAL] OK, thank you. So I do show that he is the subscriber on this general policy and yes ma'am, it is still active. The effective date is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And if you all do file a claim with us, [PII], once the claim has been processed, we do have a portal that you can check claim status in by going to [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and then can I have a patient's annual maximum please?
[AGENT][NEUTRAL] Yes, ma'am.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] The calendar year maximum benefit on this policy is $500 for covered person for covered services.
[CUSTOMER][NEUTRAL] And then has he used anything?
[AGENT][NEUTRAL] And there is
[AGENT][NEUTRAL] And give me just a moment to verify the deductible.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And there is a $50 per person.
[AGENT][NEUTRAL] Calendar year deductible and you're wanting to know if there have been any benefits used for this calendar year, is that correct?
[CUSTOMER][POSITIVE] Yes, yes, please.
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] As of now, no ma'am, there has not been.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then um.
[CUSTOMER][NEUTRAL] Does he have coverage for an FMX? Can you check that please for 0210?
[AGENT][NEUTRAL] Are you wanna know if he has history on file for that code?
[CUSTOMER][NEUTRAL] Yes, please if you can check that.
[AGENT][NEUTRAL] It shows the last date of service was [PII].
[CUSTOMER][NEUTRAL] And is there a frequency for that?
[AGENT][NEUTRAL] It's limited to one X-ray procedure for five-year period.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And then um can you please check if fluoride is covered?
[AGENT][NEUTRAL] What is the code?
[CUSTOMER][NEUTRAL] It's 1206.
[CUSTOMER][NEUTRAL] 1206.
[AGENT][NEUTRAL] It is not, uh, just one moment.
[AGENT][NEGATIVE] It is not.
[CUSTOMER][POSITIVE] OK thanks.
[AGENT][POSITIVE] Yes, ma'am. And is there anything else that I can help you with today?
[CUSTOMER][NEUTRAL] No, that's it thanks.
[AGENT][POSITIVE] OK, well, you're very welcome and thank you for calling APO. I hope you have a very nice weekend.
[CUSTOMER][POSITIVE] You too thank you bye bye.
[AGENT][POSITIVE] Thank you. You're welcome. Bye-bye.