AccountId: 011433970860
ContactId: 5cd00788-a578-41d1-b781-19780b65de16
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 351540 ms
Total Talk Time (AGENT): 119423 ms
Total Talk Time (CUSTOMER): 136859 ms
Interruptions: 0
Overall Sentiment: AGENT=1.4, CUSTOMER=0.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/02/5cd00788-a578-41d1-b781-19780b65de16_20250102T16:21_UTC.wav
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[AGENT][NEUTRAL] Calling APL, my name is [PII]. How may I assist you today?
[CUSTOMER][NEUTRAL] Good morning [PII]. My name is [PII], and I had a few questions regarding about a patient's benefits eligibility.
[AGENT][POSITIVE] I'd be happy to assist with eligibility. I'm sorry, can you repeat your first name for me?
[CUSTOMER][NEUTRAL] Yeah, of course, [PII]
[AGENT][POSITIVE] Oh [PII], OK, and [PII], if I can get a good call back number for you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] And what is the policy number?
[CUSTOMER][NEUTRAL] OK one second, um, alright, so it's gonna be 2361-985.
[AGENT][NEUTRAL] Patient's name and date of birth?
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][NEUTRAL] Thank you for that information. Please be advised the verification of coverage is not a guarantee of payment. I do show the policy is currently active. Effective date is.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] [PII].
[AGENT][NEUTRAL] And were you needing a fax back breakdown of the benefits?
[CUSTOMER][NEUTRAL] Uh, yes, if you will be able to send that form to me.
[AGENT][NEUTRAL] OK, one moment.
[AGENT][NEUTRAL] And what is that fax number?
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] OK, you should receive that fax in the next 7 to 10 minutes. Was there anything else I could assist with today?
[CUSTOMER][NEUTRAL] Uh yes, um, just like a few questions regarding their benefits, um, what is the frequency for their bite wings?
[AGENT][NEUTRAL] Sure.
[AGENT][NEUTRAL] Mm. That is once per 12-month period.
[CUSTOMER][NEUTRAL] 1 for 12 months.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] Perfect and then exams is 2 and 12.
[AGENT][NEUTRAL] Exam
[AGENT][NEUTRAL] Yep, 2 for 12 month period.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] Perfect then pro fees is each 6 months?
[AGENT][NEUTRAL] Yeah, once every 6 months, yes.
[CUSTOMER][NEUTRAL] And then exam pro feet and X-rays they apply to the max.
[AGENT][POSITIVE] I am pro.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] And Pao is one.
[AGENT][NEUTRAL] Well, no, no, no, the exams preventative is covered at 100%.
[CUSTOMER][NEUTRAL] OK, and then, but do they apply to the maximum?
[AGENT][NEUTRAL] Well, yeah, yeah, the maximum. I'm sorry, I was thinking deductible. I'm sorry, uh, I got it mixed up.
[CUSTOMER][NEUTRAL] OK, OK.
[CUSTOMER][NEUTRAL] You're OK. No, you're OK and then are X-rays covered?
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] Yes, at 80%.
[CUSTOMER][NEUTRAL] At 100%.
[CUSTOMER][NEUTRAL] 80%.
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] Is the annual maximum still 1500?
[AGENT][NEUTRAL] Um, let's see if they've used any.
[AGENT][NEUTRAL] Oh, it's a new year, yeah.
[AGENT][POSITIVE] That's easy.
[CUSTOMER][NEUTRAL] I know, right? It all starts back up again.
[AGENT][NEUTRAL] I just realized that yeah, he has no claims for this year.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Has it been busy for you guys?
[AGENT][NEUTRAL] No.
[AGENT][NEUTRAL] So he has a full $1500 available and he needs to meet his deductible again.
[CUSTOMER][NEUTRAL] Which is 50.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] Perfect and then I think I just had a few more questions on the fax it will have everything breaking down for me.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK, um, I think I just.
[AGENT][NEGATIVE] Now if you don't see a code on there, it means it's not covered.
[CUSTOMER][MIXED] OK, but I don't see a code perfect and then.
[CUSTOMER][NEUTRAL] One more or two more questions, uh, for 2394, are those covered or is that covered and do they covered by cuspids and molars or do they downgrade to an amalgam benefit?
[AGENT][NEUTRAL] You said 2394, that is covered under basic and we don't do downgrades.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][POSITIVE] Perfect.
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] And then
[CUSTOMER][NEUTRAL] For dentures or the replacement periods once every 6 months?
[AGENT][NEUTRAL] Uh, once every, is that 5 years?
[CUSTOMER][NEUTRAL] Yes.
[AGENT][NEUTRAL] OK, yeah, then yes.
[CUSTOMER][NEUTRAL] And then do you guys pay on prep or seat date?
[AGENT][NEUTRAL] C.
[CUSTOMER][POSITIVE] Perfect. And then lastly for 2740, are they covered on posterior teeth?
[AGENT][NEUTRAL] 2740.
[AGENT][NEUTRAL] Um, there is no, it's not stating there's a limitation for that.
[CUSTOMER][NEUTRAL] OK perfect and then are implants covered?
[AGENT][NEUTRAL] No.
[CUSTOMER][POSITIVE] Perfect um.
[CUSTOMER][NEUTRAL] Oh, and lastly, do they have out of network benefits?
[AGENT][NEUTRAL] Yeah, there is no network, so there are no in or out of network benefits. It just pays regardless of where they go.
[CUSTOMER][NEUTRAL] Oh perfect OK and is the group number still 12085?
[AGENT][POSITIVE] That's correct.
[CUSTOMER][POSITIVE] Perfect, um, other than that that was all thank you.
[AGENT][POSITIVE] Thank you for calling APL. You have a good day.
[CUSTOMER][POSITIVE] Thank you you too take care.
[AGENT][NEUTRAL] Mhm bye bye.
[CUSTOMER][NEUTRAL] Bye.