AccountId: 011433970860
ContactId: 556d9d19-42e2-4824-8909-d2389ddc6658
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 337079 ms
Total Talk Time (AGENT): 137237 ms
Total Talk Time (CUSTOMER): 119301 ms
Interruptions: 0
Overall Sentiment: AGENT=1.3, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/556d9d19-42e2-4824-8909-d2389ddc6658_20250121T13:56_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi [PII], my name is [PII]. I just need the benefits. Hello, can you hear me? Can you hear me?
[AGENT][NEUTRAL] Hello.
[AGENT][NEUTRAL] Hello?
[AGENT][NEUTRAL] I can hear you now. I, I can now.
[CUSTOMER][NEUTRAL] Sorry about that. Um, my name is [PII]. I just need a benefits breakdown for a member.
[AGENT][NEUTRAL] OK, and then I, you, you're needing a fax back of, is this for dental?
[CUSTOMER][NEUTRAL] Yeah, it's dental um I received the fax back but the fax back um is I can't understand it so I just have a couple questions.
[AGENT][NEUTRAL] OK, yes, ma'am, I can help you with that. And what is your callback number?
[CUSTOMER][NEUTRAL] Um, [PII] option two.
[AGENT][NEUTRAL] Thank you and the member's policy number, please, I?
[CUSTOMER][NEUTRAL] Um, 02543230.
[AGENT][POSITIVE] Thank you. One moment, please.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mm
[AGENT][NEUTRAL] And any information that I do provide for you today would be a verification of benefits and not a guarantee of payment. What is your patient's name and their date of birth?
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] Um, [PII], date of birth is [PII].
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] OK, so she is a subscriber on this policy and it is active with an effective date of [PII].
[AGENT][NEUTRAL] And one moment for me to get her, OK. Go ahead.
[CUSTOMER][NEUTRAL] OK, um
[CUSTOMER][NEUTRAL] OK, no, sorry about that, um, sorry about that, um, I just need to know you have the maximum?
[AGENT][NEUTRAL] I'm sorry, say that again.
[AGENT][NEGATIVE] Your voice is cutting out. OK, it should be on page one.
[CUSTOMER][NEUTRAL] Maximums.
[CUSTOMER][NEGATIVE] I know it's my fault.
[AGENT][NEUTRAL] It should be on page one of your facts back under the patient's name and effective date. Calendar year max is $500 for covered insured with a calendar year deductible of $50.
[CUSTOMER][NEUTRAL] Um, yeah, it looks like it wasn't, yeah, um, OK, 500 and then mm mm, I see her.
[AGENT][NEUTRAL] It wasn't.
[CUSTOMER][NEUTRAL] Deductible, but I don't see the maximum on that. That's why I was kinda confused, um, and then I just wanna confirm I didn't see major on there either, so I wanna make sure that it's covered. It's not covered. OK. um, is endodontics, Perodontics, and oral surgery also under major?
[AGENT][NEUTRAL] Mm
[AGENT][NEUTRAL] I
[AGENT][NEGATIVE] It is not covered.
[AGENT][POSITIVE] Correct.
[AGENT][NEUTRAL] Anything that is not listed under that category of expenses covered would not be covered under this policy.
[CUSTOMER][NEUTRAL] OK and then um.
[CUSTOMER][NEUTRAL] Let's see, the other question I had is um SRP so code 4341.
[AGENT][NEUTRAL] Again, if it's not, I don't think that's not covered.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] OK, um, I guess I'll just.
[AGENT][NEUTRAL] Now, I'll be, I'll be happy to send you another fax back if you're missing part of the top section because you should see patient name, policy certificate, effective date, coverage status and right under that should be the calendar year max.
[CUSTOMER][NEUTRAL] OK, yeah, if you can send it back, um, the fax number is [PII].
[AGENT][NEUTRAL] OK, give me that again. [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] OK, give me one moment, please.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] From where?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] An area of flat trying to land especially a desert basin.
[CUSTOMER][NEUTRAL] Mother
[CUSTOMER][NEUTRAL] on
[AGENT][NEUTRAL] And I don't know if the person you spoke with before gave you our portal, but we do have a portal that I, uh, that you once the claim has been processed with APL that you should be able to have access to the explanation of benefits for the member, and that portal website for that is [PII].
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][POSITIVE] You are very welcome. And is there anything else at the moment I can help you with?
[CUSTOMER][NEUTRAL] No, that's it.
[AGENT][POSITIVE] OK, well then, thank you again for calling APL and I hope you have a wonderful day.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][POSITIVE] Yes, ma'am. Thank you. Bye-bye.