AccountId: 011433970860
ContactId: 57d7fe2c-f9c6-47e2-8d8d-725d479a5012
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 626520 ms
Total Talk Time (AGENT): 229254 ms
Total Talk Time (CUSTOMER): 224816 ms
Interruptions: 1
Overall Sentiment: AGENT=-0.1, CUSTOMER=0.4
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/25/57d7fe2c-f9c6-47e2-8d8d-725d479a5012_20250625T18:16_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Yes, hello, sir. My name is [PII] calling from dental office and I'm looking for dental benefits for the patient.
[AGENT][POSITIVE] OK, sure, I can assist you with dental benefits, Miss. [PII]. May I have a callback number just in case we get disconnected?
[CUSTOMER][NEUTRAL] OK. Uh, code number is [PII].
[AGENT][NEUTRAL] Thank you. And may I have the name of the facility you're calling from for my notes?
[CUSTOMER][NEUTRAL] OK. It is Dental Dental Corporation.
[AGENT][NEUTRAL] Delta Dental.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] May I have the patient's policy number, Mr. [PII]?
[CUSTOMER][NEUTRAL] OK. It is um 243-74887.
[AGENT][POSITIVE] Thank you. One moment.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] May I have the name and date of birth of the patient?
[CUSTOMER][NEUTRAL] OK. Name is
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] You
[CUSTOMER][NEUTRAL] And date of birth is [PII].
[AGENT][POSITIVE] OK, thank you.
[CUSTOMER][NEUTRAL] This
[AGENT][NEUTRAL] And you need a full breakdown given to you verbally or faxed over to you?
[CUSTOMER][NEUTRAL] Mm, please have 4 breakdowns.
[AGENT][NEUTRAL] Verbal?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] You
[AGENT][NEUTRAL] One moment.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK, before I give you benefit information, I need to let you know that this is not a guarantee of payment, just a verification of coverage, and that's just a disclaimer. We have an effective date of [PII]. It is active at the moment and this is one of our basic dental policies.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] good
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] With this one, there is a calendar year maximum of 500 with the calendar year deductible of 50.
[AGENT][NEUTRAL] And this one we have a preventative or cover 100%.
[AGENT][NEUTRAL] Radiograph FMX is covered at 80%.
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Basic and basic restorative is covered at 80%.
[AGENT][NEGATIVE] And there's no major service. So endodontics, periodontics, prosthodontic repair, oral surgery, crowns and bridges are not covered.
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] M M N DT right.
[CUSTOMER][NEUTRAL] OK. So, um, it covers only the preventative and restorative basics, right?
[AGENT][POSITIVE] Correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And so, um, I have, uh, specific questions. Can you, uh, can I ask you, um,
[AGENT][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] There's no
[CUSTOMER][NEUTRAL] Yes. Uh, can you tell me the group name and the group number?
[AGENT][NEUTRAL] OK, be me, let me get back.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] OK, the group name is TRC Staffing.
[CUSTOMER][NEUTRAL] know.
[AGENT][NEUTRAL] The group number is 70055.
[CUSTOMER][NEUTRAL] 00
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK. And so, uh, just to confirm, um, the code 4341 is not covered, right?
[AGENT][NEUTRAL] That is correct. That's not covered.
[CUSTOMER][NEUTRAL] 021
[CUSTOMER][NEUTRAL] Mhm. And for the
[CUSTOMER][NEUTRAL] Basic uh 2391 is 1 for 24 months, 80%.
[CUSTOMER][NEUTRAL] And I
[AGENT][NEUTRAL] What is the code again?
[CUSTOMER][NEUTRAL] 2391.
[AGENT][NEUTRAL] 2691.
[CUSTOMER][NEUTRAL] 2391.
[AGENT][NEUTRAL] 2391. OK, bear with me, let me see.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] That's
[AGENT][NEUTRAL] OK, so that one is going to be under basic restorative, and that's going to be uh replaced existing only in place for 24 months. So yes, that is 80%.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And what composite downgrade to Amaga?
[AGENT][NEUTRAL] No, we don't downgrade.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm. And so, uh, this, the, that's the only codes are for basics, right?
[AGENT][NEUTRAL] Can you repeat?
[CUSTOMER][NEUTRAL] That's the only cover for that code 2391 for basics, right?
[AGENT][NEGATIVE] I'm not understanding your question. I'm not understanding.
[CUSTOMER][NEUTRAL] I mean, uh, the other.
[CUSTOMER][NEUTRAL] The other costs, the, the other codes is uh not covered for basic.
[AGENT][NEUTRAL] What other codes?
[CUSTOMER][NEUTRAL] Mm, so, uh, the 4 [PII].
[AGENT][NEGATIVE] No, that's not covered.
[CUSTOMER][NEUTRAL] For chief voice.
[AGENT][NEUTRAL] Not covered?
[CUSTOMER][NEUTRAL] Mhm. [PII].
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] [PII]
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] Mhm. [PII].
[AGENT][NEGATIVE] Not cover.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] [PII], let me see, not covered.
[CUSTOMER][NEUTRAL] Mhm. And [PII].
[AGENT][NEUTRAL] What's the number again?
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEGATIVE] Not covered.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And [PII]?
[AGENT][NEUTRAL] OK [PII] is not covered.
[CUSTOMER][NEUTRAL] Fluoride is not covered?
[AGENT][NEUTRAL] Not that cold, we cover [PII].
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Not [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm. And [PII].
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] [PII] is not covered.
[CUSTOMER][NEUTRAL] Mhm. And [PII].
[AGENT][NEUTRAL] OK, so that one is gonna be under preventative and that's once every 6 months.
[CUSTOMER][POSITIVE] OK. Thank you so much. And then uh what is the coordination of benefits?
[AGENT][NEUTRAL] Mhm
[AGENT][NEUTRAL] We don't coordinate?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh so is there any history for this year or the previous year?
[AGENT][NEUTRAL] History, you said?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, let me check on that one moment.
[AGENT][NEUTRAL] Mm OK. I got some for last year. I got a trophy on [PII]. I got an oral evaluation on [PII].
[AGENT][POSITIVE] I got a bite win on [PII].
[CUSTOMER][NEUTRAL] And
[AGENT][NEUTRAL] And it looks like that's all the history.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Thank you so much. And please, can you spell out your names and the reference number?
[AGENT][NEUTRAL] Mm.
[AGENT][NEUTRAL] My name is [PII]. That's [PII], last initial [PII]. We don't have reference numbers, you can use my name in today's date.
[CUSTOMER][NEUTRAL] OK. And so, so, um, I have a one last patience, and can you repeat that?
[AGENT][NEUTRAL] OK, is it a different member or is it the same policy.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] Same, same.
[AGENT][NEUTRAL] What's the name and date of birth?
[CUSTOMER][NEUTRAL] OK. Uh, my name is
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] And [PII].
[AGENT][NEUTRAL] OK, so all the information about the benefits is the same. The effective date and everything is the same. Now, let me check the history. That's the only thing that is gonna be probably different.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Um, OK, so on the history, it looks like it's also gonna be the same. She did a prophy [PII] oral examination, [PII].
[AGENT][NEUTRAL] And that's all I got for her.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK. And uh this patient is, uh, this, uh, the provider is in or out of network.
[AGENT][NEGATIVE] There's no network with this policy.
[CUSTOMER][POSITIVE] OK. OK. Thank you so much for your help, sir.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] Is there anything else I may help you with today?
[CUSTOMER][POSITIVE] Mm, no, that's all. Thank you so much for your help.
[AGENT][POSITIVE] Thank you. You're welcome. Thank you for calling APL. Have a good day.
[CUSTOMER][NEUTRAL] OK. You too. Bye-bye.
[AGENT][POSITIVE] Thank