AccountId: 011433970860
ContactId: 5601a180-69a4-4d94-840a-7db68d839555
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 487420 ms
Total Talk Time (AGENT): 154086 ms
Total Talk Time (CUSTOMER): 151771 ms
Interruptions: 0
Overall Sentiment: AGENT=0.3, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/03/31/5601a180-69a4-4d94-840a-7db68d839555_20250331T20:41_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] But.
[CUSTOMER][NEUTRAL] Hello, this is [PII] calling from Jefferson Dental. I'm calling to verify dental eligibility and benefits. Could you please help me on that?
[AGENT][POSITIVE] Yes, I can help you with eligibility and benefits. Do you have a good callback number?
[CUSTOMER][NEUTRAL] Yeah, it would be [PII]. It's a direct line with no extension.
[AGENT][NEUTRAL] And the patient policy ID?
[CUSTOMER][NEUTRAL] 402
[CUSTOMER][NEUTRAL] Uh, you're asking me for member ID?
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] 02606406
[AGENT][NEUTRAL] Patient name and date of birth?
[CUSTOMER][NEUTRAL] Patient's name is [PII]. [PII].
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] OK, the policy is active and effective [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Do you want me to send a fax back? It outlines all of what's covered under the policy. I can fax that to you?
[AGENT][NEUTRAL] Right now.
[CUSTOMER][POSITIVE] Uh no, I'll take the benefits in the call.
[CUSTOMER][NEUTRAL] Uh, if you don't mind, can you like, uh, um, I can't, like I can't able to get your voice.
[AGENT][NEUTRAL] Yep.
[AGENT][NEUTRAL] OK, you, you say you do wanna fax or you or you don't?
[CUSTOMER][POSITIVE] Uh, I'll take it in the call. I'll take the patient benefits in the call, no need of fax.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] People
[AGENT][NEUTRAL] Again, it's not a guarantee of payment basic outline of the policy. There is a $500 calendar year maximum benefit.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Preventative services.
[CUSTOMER][NEUTRAL] How about deductibles?
[AGENT][NEUTRAL] Preventative services pay 100%. There's a $50 deductible for basic services. There are no major services on this policy.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, so the the uh deductibles are 5, 150, and uh the annual max is 500. The preventive basic uh major services are covered at 180 and 0. There's no major service.
[AGENT][POSITIVE] Yes, that's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK, is there an, uh, like, mm.
[CUSTOMER][NEUTRAL] Is there any huge amount out of $500?
[AGENT][NEUTRAL] Uh, the, the deductible is 50.
[AGENT][NEUTRAL] Is that what you're asking of the 500 though you're asking?
[CUSTOMER][NEUTRAL] No, is there any met amount? Is there any met amount or used amount?
[AGENT][NEUTRAL] Um, let's see.
[CUSTOMER][POSITIVE] Let's go let's go.
[CUSTOMER][POSITIVE] Thanks we'll do it for next month.
[CUSTOMER][NEUTRAL] Look it up
[CUSTOMER][NEUTRAL] It's
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][POSITIVE] OK, take your time.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEGATIVE] Uh, no, they don't haven't met anything so far and haven't used anything.
[CUSTOMER][NEUTRAL] OK, nothing new or nothing much, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK, is there, um, is there any history which might affect the patient's frequency?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Is there any history which might affect the patient's frequency?
[AGENT][NEUTRAL] Is there any age limit? is that what you said?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] History
[AGENT][NEUTRAL] History.
[AGENT][NEUTRAL] No, I, I don't, um.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] Let's see, no, I, I don't have anything. They haven't used anything at all, so there's no history on file.
[CUSTOMER][NEUTRAL] OK, there's no history for the patient, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] Is is orthodontics a covered benefit?
[AGENT][NEUTRAL] I'm sorry?
[CUSTOMER][NEUTRAL] Is orthodontics a covered benefit?
[AGENT][NEUTRAL] Orthodontics, um, let's see.
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEGATIVE] Uh, no, no coverage for orthodontics.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Is the patient policy holder here?
[AGENT][NEUTRAL] The patient policyholder is [PII].
[CUSTOMER][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] What was the question?
[CUSTOMER][NEUTRAL] Is the patient policy holder?
[AGENT][NEUTRAL] Is the patient policy what? I'm sorry.
[CUSTOMER][NEUTRAL] Is the patient policy holder or is he dependent?
[AGENT][NEUTRAL] [PII] is the dependent.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Will you verify me with the uh claiming address, sorry, mailing address?
[AGENT][NEUTRAL] Mailing address is [PII].
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Sorry, what's the zip code?
[AGENT][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Payer ID?
[AGENT][NEUTRAL] 60801.
[CUSTOMER][NEUTRAL] Mhm, what's the fee schedule?
[AGENT][NEUTRAL] Usual customary.
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] It's it's subject to usual and customary determination.
[CUSTOMER][NEUTRAL] Hello
[CUSTOMER][NEUTRAL] I
[AGENT][NEUTRAL] So I don't, I don't have a dollar amount.
[CUSTOMER][NEUTRAL] The
[AGENT][NEUTRAL] It'll pay 100% for preventative and then 80% for basic.
[CUSTOMER][NEUTRAL] Mhm OK.
[AGENT][NEUTRAL] What's usual.
[CUSTOMER][NEUTRAL] So the effective date is [PII] [PII], right?
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Yeah, OK, will you help me with your call reference number and your name?
[AGENT][NEUTRAL] It's my name, [PII], last initial [PII], and today's date.
[CUSTOMER][NEUTRAL] Could you spell out your name?
[AGENT][NEUTRAL] [PII] and then [PII].
[CUSTOMER][NEUTRAL] How do you spell it?
[AGENT][NEUTRAL] [PII] is the last initial, the last initial of my last name, or the first initial of my last name, so it's [PII] and then [PII]
[AGENT][NEUTRAL] As [PII].
[AGENT][NEUTRAL] We don't give out our last names, it's just our initials.
[CUSTOMER][NEUTRAL] Yeah, could you spell out your first name?
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, thank you, and I'm done with the patient. It was great [PII]king to you. Have a great day and bye bye.
[AGENT][POSITIVE] OK, thanks for calling APL. Have a good day.