AccountId: 011433970860
ContactId: 59eb3813-fb3d-4af0-aa98-b42b34137266
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 301619 ms
Total Talk Time (AGENT): 149696 ms
Total Talk Time (CUSTOMER): 92721 ms
Interruptions: 0
Overall Sentiment: AGENT=1.2, CUSTOMER=0
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/04/59eb3813-fb3d-4af0-aa98-b42b34137266_20250404T14:05_UTC.wav
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[AGENT][POSITIVE] Good morning. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hi, my name is [PII] and I'm calling from Jefferson Dental to verify the eligibility and benefits for a patient. Can you please help me with that?
[AGENT][POSITIVE] [PII], it would be my pleasure to assist you with eligibility and benefits. What is the callback number?
[CUSTOMER][NEUTRAL] Yes, that would be [PII] and there will be no extension.
[AGENT][NEUTRAL] Thank you, [PII]. And the policy number for the patient, please?
[CUSTOMER][NEUTRAL] That would be 00914813.
[AGENT][NEUTRAL] And what is the patient's name and date of birth, please?
[CUSTOMER][NEUTRAL] Yes. The patient name would be [PII] and the date of birth would be [PII].
[AGENT][NEUTRAL] All right, thank you. And are you, is this for dental?
[CUSTOMER][NEUTRAL] Yes, this is for the rental.
[AGENT][POSITIVE] All right, yeah, I can help you with eligibility and benefits.
[AGENT][NEUTRAL] I am showing that [PII]'s policy is active with the effective date of [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And I do have a breakdown that I can fax to you if you're interested in that as well.
[CUSTOMER][NEUTRAL] OK. Can you please repeat the uh effective date, please? [PII] of.
[AGENT][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] Mhm. OK. And may I know the deductibles amount and the yearly maximum, please?
[AGENT][NEUTRAL] Yes you can and all benefits given over the phone is a verification of coverage, not a guarantee of payment.
[AGENT][NEUTRAL] The calendar year max benefit is $1500.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] There is a $50 deductible up to $150 per family, but this is an individual policy.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And the deductible does not apply to preventive expenses.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Mhm
[CUSTOMER][NEUTRAL] And the co-insurance percentages for preventive basic and major would be?
[AGENT][NEUTRAL] Preventive is 100% of usual customary rate.
[AGENT][NEUTRAL] Radiographs, FMX basic and basic restorative expenses are 80%.
[AGENT][NEUTRAL] And your major expenses, including endodontic, periodontic, prosthodontic repair, and oral surgeries is 40%.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the group number and also the group name would be?
[AGENT][NEUTRAL] Mhm. The group number is 14564.
[AGENT][NEUTRAL] Group name is Universal Trucking.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Anderson flatbed.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Mhm. And is there any waiting period for this policy?
[AGENT][NEUTRAL] There was a 12 month waiting period for major expenses that has been satisfied.
[CUSTOMER][NEUTRAL] OK, and uh what will be the fee schedule for this plan?
[AGENT][NEUTRAL] I'm can you repeat that question?
[CUSTOMER][NEUTRAL] Yeah, the fee schedule.
[AGENT][NEUTRAL] It's UCR
[AGENT][NEUTRAL] There's no network participation, yeah.
[CUSTOMER][NEUTRAL] She's here, OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And also, can you please help me with the history of this patient that may affect the frequency?
[AGENT][NEUTRAL] Mhm, I certainly can.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] I'm checking, bear with me.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] On [PII] bye wings and comprehensive oral evaluation.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And there was a panel on [PII].
[CUSTOMER][NEUTRAL] And that's orthodontics is a covered benefit of the plan.
[AGENT][NEUTRAL] And that's it.
[AGENT][NEUTRAL] It is not
[CUSTOMER][NEGATIVE] It's not a benefit, OK. And nothing has been met and nothing has been used, right from the deductibles and the.
[AGENT][NEUTRAL] For
[AGENT][NEUTRAL] For [PII], you are correct. No met nothing used.
[CUSTOMER][NEUTRAL] Mhm. So, can you please give me the call reference number?
[AGENT][NEUTRAL] Call reference number is my name and today's date and I spell my name [PII]
[AGENT][NEUTRAL] First initial last name, [PII].
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][POSITIVE] And [PII], it was a pleasure to assist you with that breakdown from [PII]. Anything else I can help you with today?
[CUSTOMER][NEUTRAL] OK, so yeah.
[CUSTOMER][NEUTRAL] No, that's all the information and uh and all the exams will share frequency, right?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] Mhm. Yeah, that's all the information I need. Thank you for assisting me. Have a great day. Bye-bye for now.
[AGENT][POSITIVE] Thank you. Thank you for calling APL [PII]. Hope you have a great day and a happy weekend.
[CUSTOMER][NEUTRAL] You too bye bye.
[AGENT][NEUTRAL] Bye bye.