AccountId: 011433970860
ContactId: 50f58062-d1d3-4b54-a28b-063f3025a5f1
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 371920 ms
Total Talk Time (AGENT): 181730 ms
Total Talk Time (CUSTOMER): 102939 ms
Interruptions: 1
Overall Sentiment: AGENT=0.9, CUSTOMER=1.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/03/50f58062-d1d3-4b54-a28b-063f3025a5f1_20250403T13:52_UTC.wav
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[AGENT][POSITIVE] Thanks for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Well, I was calling to see if you can help me with my patient's dental benefits, please.
[AGENT][POSITIVE] Sure, I can assist you with that. Can I have your name and a callback number?
[CUSTOMER][NEUTRAL] Uh, [PII] and it's [PII].
[AGENT][POSITIVE] Thank you so much.
[AGENT][NEUTRAL] And what is that policy number of the member that you're inquiring benefits for today?
[CUSTOMER][NEUTRAL] Um, it is.
[CUSTOMER][NEUTRAL] 02597328
[AGENT][NEUTRAL] Could you verify that patient's name and date of birth?
[CUSTOMER][NEUTRAL] Yes, it is uh [PII] [PII] I mean [PII].
[AGENT][POSITIVE] Thank you.
[AGENT][NEUTRAL] [PII], you're calling to verify dental benefits. This policy has been active since [PII] and it's currently active.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] This member has a maximum benefit amount?
[CUSTOMER][NEUTRAL] Can I have a good
[AGENT][NEUTRAL] Of $500.
[CUSTOMER][POSITIVE] I'm sorry about that.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] $500 per calendar year with a $50 deductible that does not apply to us preventative services. This is not a guarantee of benefits, it's just a disclaimer of the policy's coverage.
[CUSTOMER][NEUTRAL] OK, can I have a group name on the policy by chance?
[AGENT][NEUTRAL] Yes, there is a group name.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] It is Ranger Service Solutions.
[CUSTOMER][NEUTRAL] Is it R A N G E R?
[AGENT][NEUTRAL] W A G N E R.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] Wenger.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] Wrangler.
[CUSTOMER][NEUTRAL] Um
[AGENT][NEUTRAL] Service solutions.
[CUSTOMER][NEUTRAL] Alrighty, um, is there any missing tooth clause or waiting period?
[AGENT][NEUTRAL] There is no waiting period because the policy only covers preventative and basic services. Major endo periorosthesis or surgery, crowns, bridges, ortho perioendo, none of that is covered under the policy. however, there is a missing tooth cloth, but I'm not sure why there's one, but there's definitely one on there.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][NEUTRAL] Um, can I have the frequency for like cleaning, exams, and X-rays, please?
[AGENT][NEUTRAL] So, um.
[AGENT][NEUTRAL] The frequencies are as follows, so.
[AGENT][NEUTRAL] Cleanings are once every 6 months with prophylaxin is once every 6 months or evaluations are 2 for 12-month period. Bite wing is once for 12 month period and full mouth X-rays and panoramic or once every 5 years.
[CUSTOMER][NEUTRAL] Fluoride and sealants aren't covered, right?
[AGENT][NEUTRAL] It's covered on the preventative at 100%.
[CUSTOMER][NEUTRAL] No age limit.
[AGENT][NEUTRAL] Um, so for fluoride.
[AGENT][NEUTRAL] Maximum maximum of 1 procedure for 12 months limited to dependent children under the age of [PII]. Seeing is maximum of 1 procedure for 6 months.
[AGENT][NEUTRAL] Limited to dependent children aged [PII].
[AGENT][NEUTRAL] No, I'm sorry. It's limited to dependent children aged [PII] for ceiling is the same as the fluoride.
[CUSTOMER][NEUTRAL] All right. And is there a frequency for, oh, go ahead.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Alright, and is basic covered at like 80%?
[AGENT][NEUTRAL] Yes, basic is covered at 80% and what's considered as basic is simple extractions of 7140 and fillings with no downgrades.
[CUSTOMER][POSITIVE] Awesome, um, is there a frequency for fillings or no?
[AGENT][NEUTRAL] Repeat yourself.
[CUSTOMER][NEUTRAL] Is there a frequency for filling?
[AGENT][NEUTRAL] Um,
[AGENT][NEUTRAL] Maximum of 1 each 2 for 24 months, replacing existing only if in place for 24 months.
[CUSTOMER][POSITIVE] Perial maintenance, that's not covered, right? I didn't, I know sometimes, OK, I know sometimes like they, it covers as preventative but it um. All right, let me see. I think I got everything I need. That was easy, which is cool. Uh, did he, is he used any of this any of this, uh, $500 calendar year max or no?
[AGENT][NEUTRAL] In October. No, ma'am.
[AGENT][NEUTRAL] No, he's not utilize any of his benefits for 25, nor does he have any history on file, [PII].
[CUSTOMER][POSITIVE] Awesome, uh, do you mind if I get the group number please?
[AGENT][NEUTRAL] The group number is 70076.
[CUSTOMER][NEUTRAL] Yes ma'am.
[CUSTOMER][POSITIVE] Awesome.
[CUSTOMER][NEUTRAL] And I think I do you mind if I get the uh the claims address and the payer ID please?
[AGENT][NEUTRAL] The payer ID is 60801.
[AGENT][NEUTRAL] The mailing address will be [PII].
[AGENT][NEUTRAL] [PII]. It's [PII], [PII].
[AGENT][NEUTRAL] It's [PII], [PII].
[CUSTOMER][POSITIVE] All right, and I'm so sorry. I did wasn't quick enough, can I have the group name one last time?
[AGENT][NEUTRAL] Wagner service solution.
[CUSTOMER][POSITIVE] Awesome, alright, uh, that's all I needed. Do you mind if I get a reference number for the call today?
[AGENT][NEUTRAL] We don't provide those unfortunately [PII]. You can use my name in today's date as a reference. Is there anything else that I can assist you with today?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Can I have your first name again? I'm horrible with names. I'm sorry.
[AGENT][NEUTRAL] [PII], and today's date. Would you like me to provide you with the date?
[CUSTOMER][POSITIVE] Awesome.
[CUSTOMER][POSITIVE] No, ma'am. I got it. Thank you.
[AGENT][POSITIVE] Alrighty, thanks for calling APL [PII] and have a good day. Goodbye.
[CUSTOMER][NEUTRAL] You too.