AccountId: 011433970860
ContactId: 55568f77-1b17-4cdf-875d-a14ec473484c
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 755880 ms
Total Talk Time (AGENT): 183387 ms
Total Talk Time (CUSTOMER): 89935 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=-1.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/25/55568f77-1b17-4cdf-875d-a14ec473484c_20250625T21:38_UTC.wav
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[AGENT][NEUTRAL] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hi, sure. It's [PII] calling from the dental products office. Uh, I need a patient's eligibility detail. Can you please help me with that?
[AGENT][NEUTRAL] OK, sure.
[AGENT][NEUTRAL] Yes, I can assist you with the eligibility. May I have a callback number just in case we get disconnected, Mr. [PII]?
[CUSTOMER][NEUTRAL] Yeah, [PII].
[AGENT][NEUTRAL] Thank you. And may I have the patient's policy number?
[CUSTOMER][NEUTRAL] 02361939
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] [PII], [PII].
[AGENT][NEUTRAL] Thank you. And you just need eligibility?
[AGENT][NEUTRAL] Do you have a specific question.
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, firstly, the question is the subscriber.
[AGENT][NEUTRAL] Yeah
[AGENT][NEUTRAL] It is, yes, and this is a dental policy which is active.
[AGENT][NEUTRAL] With an effective date of [PII].
[CUSTOMER][POSITIVE] Thank you. Uh,
[CUSTOMER][NEUTRAL] Are there some specific codes. Can you please help me with that?
[AGENT][NEUTRAL] Bear with me, let me pull the schedule benefits.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, and I'm gonna need them one by one.
[CUSTOMER][NEUTRAL] OK. Uh,
[CUSTOMER][NEUTRAL] 0220
[AGENT][NEUTRAL] 0220, that's on basic expense. There's no limitation, that's 80%.
[CUSTOMER][NEUTRAL] 1110.
[AGENT][NEUTRAL] That's under um preventative, which is 100% and that's once every 6 months.
[CUSTOMER][NEUTRAL] I'm sorry, once in 6 months?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] OK. Uh 0120.
[AGENT][NEUTRAL] OK, um, that is, uh, let's see, and they're preventative and that's going to be, let's see, one moment.
[AGENT][NEUTRAL] Limited to two oral evaluation procedures and any combination of 120, 140, 150, 160, and 180 for 12 month period.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 0140.
[AGENT][NEUTRAL] Is that 0140?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, it's gonna be um the same thing. It's limited to two or evaluation procedures in any combination of 120, 140, 150, 160, and 180. Now, the 140 is part of the um basic expense.
[CUSTOMER][NEUTRAL] OK. Um 521 2.
[AGENT][NEUTRAL] OK, [PII], that's going to be under, let's see, major expense which is 40% after the 12 month waiting period and this number is out of the waiting period.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEUTRAL] I'm sorry, you said [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII] is not covered.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] is not covered.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII] is not covered.
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hello, Mr. [PII], I cannot hear you. OK.
[CUSTOMER][POSITIVE] Thank you. Uh [PII].
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] [PII] is not covered.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], that's going to be under major expense which is 40% after the um 40%.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] 4266
[AGENT][NEUTRAL] Now that's 4266.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK. 4266 is not covered.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] 2950, that's gonna be under major expense which that is 40% and it looks like that's going to be a limitation of maximum of 17 year period.
[CUSTOMER][POSITIVE] Thank you. Uh.
[AGENT][NEUTRAL] Mm
[CUSTOMER][NEUTRAL] What is the payer ID number?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] Thank you. Uh, is there any history on file that can affect frequency?
[AGENT][NEUTRAL] I can check. One moment please.
[AGENT][NEUTRAL] And this is only for [PII]?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, so it looks like we have a [PII] on [PII] and we have a [PII] on [PII], and that's all in the history.
[CUSTOMER][NEUTRAL] OK, thank you. Can you fax me back the patient's benefit details?
[AGENT][NEUTRAL] What is the fax number?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, um, do you mind holding for me while I send this out to you while I got you on the line?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][POSITIVE] One moment. Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding and being patient for Mr. [PII]. I went ahead and send that over to you. It should be there in a few minutes. Is there anything else I can help you with today?
[CUSTOMER][POSITIVE] And that's it. Thank you so much uh for providing the information, and you have a wonderful rest of your day. Bye for now.
[AGENT][NEUTRAL] Neuroscope. Thank you. Bye-bye, Mr. [PII].