AccountId: 011433970860
ContactId: 53869135-905e-4757-9488-ab049e9b4978
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 401029 ms
Total Talk Time (AGENT): 191050 ms
Total Talk Time (CUSTOMER): 147706 ms
Interruptions: 0
Overall Sentiment: AGENT=0.4, CUSTOMER=2.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/07/53869135-905e-4757-9488-ab049e9b4978_20250107T23:05_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. My name is [PII] calling on behalf of the dental office to check eligibility and benefits for a patient on a recorded line. So can you please help me with that?
[AGENT][NEUTRAL] Yeah, I can check the uh eligibility and benefits for you. I'm sorry, what did you say your name was?
[CUSTOMER][NEUTRAL] [PII], [PII]
[AGENT][NEUTRAL] OK, let's see, so can I get a good call back number from you in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. It's [PII].
[AGENT][NEUTRAL] Thank you. And then do you have the policy number?
[CUSTOMER][NEUTRAL] Yes, it's 02521295.
[AGENT][NEUTRAL] OK, thank you. And what was the name and date of birth for the insured?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] OK, thank you for verifying that [PII]. Uh, so this policy is active. Effective date was [PII], and if you'd like, I can send you the fax back that shows all covered procedures and benefit information.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Um, actually, [PII], I have some limited questions. So could you provide me overview, please, if it's possible?
[AGENT][POSITIVE] Could you repeat that, [PII]? I'm so sorry.
[CUSTOMER][NEUTRAL] Yes, actually, I have some specific questions. I don't, I have only limited questions I have. So could you provide me verbally, please?
[AGENT][NEUTRAL] Oh sure.
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So
[CUSTOMER][NEUTRAL] OK, so there is a waiting period, right, as well as there is a missing tooth cloths on file?
[AGENT][NEUTRAL] That's correct. Um, there is a missing teeth colors waiting period of 12 months for all major expenses, including endodontic, periodontic, and oral surgery.
[CUSTOMER][NEUTRAL] OK, got it. And what about the annual maximum deductible as well as anything you from it for this year?
[AGENT][NEUTRAL] Of course, um, of course I will let you know see so verification of coverage is not a guarantee of payment for claims. Um, the annual year max is $1500 per insured.
[AGENT][NEUTRAL] And there is a deductible of $50 per year, uh, does not apply to preventative expenses and give me one moment, uh, so nothing has been used so far this year.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Awesome. Thank you so much. And it's a 18,040 plan, right?
[AGENT][POSITIVE] It's, I'm so sorry, what was that?
[CUSTOMER][NEUTRAL] What about the coinsurance for the preventive basic and major services?
[AGENT][NEUTRAL] Yeah, so if this plan goes off of UCR. There's not a set network, so preventative, uh, would be at 100, uh, radiographs basic would be at 80, and all major would be at 40.
[CUSTOMER][POSITIVE] Awesome. Thank you so much. So can, actually, I have some specific quotes, probably 5 to 7 quotes and I want to know the percentage and frequencies. So can I give you one by one or all at once?
[AGENT][NEUTRAL] Of course.
[AGENT][NEUTRAL] Uh, whatever is easier for you.
[CUSTOMER][NEUTRAL] Um, can I give you all at once?
[AGENT][NEUTRAL] Sure.
[CUSTOMER][POSITIVE] Awesome. Thank you so much. So, yes, are you ready?
[AGENT][NEUTRAL] Yes, sir.
[CUSTOMER][NEUTRAL] Yes, starting with the 0470.
[CUSTOMER][NEUTRAL] 2991.
[CUSTOMER][NEUTRAL] 43,467,140
[CUSTOMER][NEUTRAL] 7953
[CUSTOMER][NEUTRAL] 6010.
[CUSTOMER][NEUTRAL] 6058. And the last one is 6057.
[AGENT][NEUTRAL] OK thank you one moment please.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, so 0470 is not going to be a covered procedure under this policy.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 2991 is also not covered.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 4346 is not covered either.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Moment.
[AGENT][NEUTRAL] OK, and a 7140 is covered under basic so that would be 80%. Give me one moment, let me look at this limitation.
[AGENT][NEUTRAL] So a maximum of one time per tooth.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] All right and then.
[AGENT][NEUTRAL] Just a moment.
[AGENT][NEUTRAL] So 7953 is not a covered procedure.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Neither is 6010.
[AGENT][NEGATIVE] 6058 is also not covered.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And neither is 605-7.
[CUSTOMER][POSITIVE] Awesome. Thank you so much for that and there is no downgrade on composite feelings, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] Awesome. As well as orthodontics is also not covered, right?
[AGENT][NEGATIVE] What, uh, no, or excuse me, that's not covered either, no, sorry.
[AGENT][POSITIVE] Orthodontic, my goodness.
[CUSTOMER][POSITIVE] OK, no worries, sir.
[CUSTOMER][POSITIVE] Yes, no worries. Thank you so much, [PII]. And last, can you check is there any history on file which would affect the frequencies?
[AGENT][NEUTRAL] Sure, let me check that.
[AGENT][NEUTRAL] And this is just for [PII] correct?
[CUSTOMER][POSITIVE] Yeah, that is correct.
[AGENT][NEUTRAL] OK, so I've only got 4 procedures from [PII] last year, um.
[AGENT][NEUTRAL] Let's see.
[AGENT][NEUTRAL] So we've got
[AGENT][NEUTRAL] 43412391 and 2740.
[CUSTOMER][NEUTRAL] 4341. So for which card rents?
[AGENT][NEUTRAL] Uh,
[AGENT][NEUTRAL] Upper left.
[AGENT][NEUTRAL] There's another one. I'm sorry, there is another 43414 lower left as well.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] The same date of service, right? [PII].
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Yes sir, and then the uh 2391 was for tooth number 17.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And 2740 was for 219.
[AGENT][NEUTRAL] And that is the only history I have on file for this individual.
[CUSTOMER][NEUTRAL] OK. Yeah.
[CUSTOMER][POSITIVE] Awesome. Thank you so much, [PII]. Yes, I'm done it all my questions. Could you provide me the call reference number please for this call?
[AGENT][NEUTRAL] Yeah, that would just be my first name, last initial, and today's date and so my name is spelled [PII] Was there anything else I could help you with [PII]?
[CUSTOMER][POSITIVE] No, thank you so much. Thank you for your help. I appreciate it.
[AGENT][POSITIVE] Alright, yeah, of course, thanks for calling APL. I hope you have a great rest of your day.
[CUSTOMER][POSITIVE] You too. Have a great day, sir. Bye-bye.
[AGENT][NEUTRAL] You too. Bye-bye.