AccountId: 011433970860
ContactId: 4bab576d-af0e-4512-b9ec-ab29d0cab9c2
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 211699 ms
Total Talk Time (AGENT): 63111 ms
Total Talk Time (CUSTOMER): 81370 ms
Interruptions: 0
Overall Sentiment: AGENT=0.6, CUSTOMER=1.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/05/4bab576d-af0e-4512-b9ec-ab29d0cab9c2_20250305T20:33_UTC.wav
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[AGENT][NEUTRAL] For calling APL, my name is [PII]. How can I assist you today?
[CUSTOMER][NEUTRAL] Hi [PII], good afternoon. This is [PII] from I Smile Dental Clinic. I'm just calling to check one of our patients' benefits for fillings. Can you help me with that?
[AGENT][POSITIVE] I'd be happy to assist with eligibility today.
[AGENT][NEUTRAL] And you said I'm sorry, your first name again? I'm sorry.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Um yeah [PII].
[AGENT][NEUTRAL] OK. [PII] and [PII] if I can get a good callback number for you?
[CUSTOMER][NEUTRAL] Sure. This is direct. That would be [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] Sure. That would be 2259801.
[AGENT][NEUTRAL] Patient's name and date of birth.
[CUSTOMER][NEUTRAL] Sure, for [PII], [PII].
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment. I do show the policy is currently active with an effective date of [PII], and were you needing a fax back breakdown of the benefits?
[CUSTOMER][NEUTRAL] I mean, I just have a specific question to ask. This is just for fillings. The code would be for the 2392 for tooth number 3 and 15. I just need to get the percentage, the frequency, if there's any downgrade and any history for fillings. Thank you.
[AGENT][NEUTRAL] OK, so that is covered under basic which is covered at 80% after the $50 deductible is met and uh let's see.
[AGENT][NEUTRAL] Oh
[AGENT][NEUTRAL] Mm, and the frequency is 1 per 5 year period per 2.
[CUSTOMER][NEUTRAL] 1 for 5 years per tooth, right?
[AGENT][NEUTRAL] And
[AGENT][NEUTRAL] Right, let me see if they have any history of that. One moment.
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] I don't see any history.
[CUSTOMER][NEUTRAL] Thank you. Is there any downgrades for filings?
[AGENT][NEUTRAL] No, we don't do downgrades.
[CUSTOMER][POSITIVE] Thank you for that one moment here.
[CUSTOMER][NEUTRAL] Alright, so just to confirm, no history and no downgrades covered under basic 80%, 1 per 5 years per tooth. So patient is eligible for tooth number 3 and 15, right?
[AGENT][NEUTRAL] Yes, there's no history.
[CUSTOMER][POSITIVE] Thank you. So yeah, I think that's it for me today. Thank you so much for your help, [PII]. If I can just have a reference number please.
[AGENT][NEUTRAL] Reference is just my name and today's date and time.
[CUSTOMER][POSITIVE] Thank you for that so that's it for me today have a great day and bye for now.
[AGENT][POSITIVE] Thank you for calling APL. Have a good day.