AccountId: 011433970860
ContactId: 53f88504-1d75-4f4b-8e30-ea9cd36e94da
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 323339 ms
Total Talk Time (AGENT): 75931 ms
Total Talk Time (CUSTOMER): 99035 ms
Interruptions: 0
Overall Sentiment: AGENT=0.8, CUSTOMER=0.7
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/30/53f88504-1d75-4f4b-8e30-ea9cd36e94da_20250430T14:17_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can
[CUSTOMER][NEUTRAL] Um, I'm calling to verify eligibility.
[AGENT][POSITIVE] Yeah, I can help you with eligibility. Could I get your name and a good callback number?
[CUSTOMER][NEUTRAL] It is [PII] and it's [PII].
[AGENT][NEUTRAL] OK, [PII], do you have the policy number of the patient?
[CUSTOMER][NEUTRAL] Um, yeah, actually I'm trying to remember who I'm calling about. Just a second, OK, it is.
[CUSTOMER][NEUTRAL] 2550082
[AGENT][NEUTRAL] And patient name and date of birth?
[CUSTOMER][NEUTRAL] Is [PII] [PII]?
[AGENT][NEUTRAL] OK, and you said benefits, is that right?
[CUSTOMER][NEUTRAL] Um, yeah, and eligibility, then I have a few questions regarding benefits.
[AGENT][NEUTRAL] OK. Uh, looks like the policy is effective [PII].
[AGENT][NEUTRAL] And not a guarantee of payment, basic outline of the policy. Uh, what benefits do we need to go over?
[CUSTOMER][NEUTRAL] Um, so first, uh, deductible and max, I just want to verify we have that correct, 500 max $50 deductible.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK, and then group number 70087.
[AGENT][POSITIVE] Yes, correct.
[CUSTOMER][NEUTRAL] OK, and then is it uh 180 for 100% preventative 80%.
[CUSTOMER][NEUTRAL] Basic and then is major not covered.
[AGENT][NEGATIVE] Majors not covered, and radiographs and FMX are also under 80%.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So the single PAs are under 80% and FMX but not by wings.
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][NEUTRAL] Or like uh 0274.
[AGENT][NEUTRAL] 74, yes, 0274 is at 80%. The only thing under preventive um is gonna be.
[CUSTOMER][POSITIVE] OK, so pretty
[AGENT][NEUTRAL] Basically atrophies, cleanings, fluoride sealants, that's about it.
[CUSTOMER][NEUTRAL] OK, um, not exams.
[AGENT][NEUTRAL] An exam.
[CUSTOMER][NEUTRAL] Like a 010 exams too, OK.
[CUSTOMER][NEUTRAL] Um, and then if so, what is, uh, fluoride is covered for or what is fluoride benefits?
[AGENT][NEUTRAL] Fluoride is
[AGENT][NEUTRAL] Uh, it's limited to children under age [PII].
[CUSTOMER][NEUTRAL] OK, and then how often is it, uh, a benefit?
[AGENT][NEUTRAL] Uh, one for 12 months.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, doke, and then also, um, are, uh, posterior composites downgraded?
[AGENT][POSITIVE] No, no downgrades.
[CUSTOMER][NEUTRAL] 2392. OK, perfect. And then also I'm calling to check on the status of an old claim.
[AGENT][NEUTRAL] OK, what is the date of service and bill charges?
[CUSTOMER][NEUTRAL] OK
[CUSTOMER][NEUTRAL] Um, [PII] 1624 and the bill amount is 434 for that one.
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] OK, 1216, 2024.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] Well, it looks like it was originally denied because we hadn't received a premium, but I, I showed that we have since received it. So let me, let me send this back through for processing. I'm not sure why they didn't take it back.
[CUSTOMER][POSITIVE] Thank you.
[AGENT][NEUTRAL] OK, yeah, I'll get that sent back through.
[CUSTOMER][POSITIVE] OK perfect thank you so much that's all I needed.
[AGENT][POSITIVE] OK, thanks for calling APL. Have a great day.
[CUSTOMER][NEUTRAL] You too bye bye.