AccountId: 011433970860
ContactId: 5d76ba97-699a-40f1-abe5-37382d981246
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 490570 ms
Total Talk Time (AGENT): 153214 ms
Total Talk Time (CUSTOMER): 182105 ms
Interruptions: 0
Overall Sentiment: AGENT=0.5, CUSTOMER=1.8
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/01/5d76ba97-699a-40f1-abe5-37382d981246_20250401T16:47_UTC.wav
--------------------------------------------
[AGENT][NEUTRAL] Thank you for calling American Public Life. This is [PII]. How may I assist you?
[CUSTOMER][NEUTRAL] Hello [PII], this is [PII]. I just wanted to verify these patients that will benefit.
[AGENT][NEUTRAL] OK. Could you verify, I mean, could you verify the callback number and the policy number?
[CUSTOMER][NEUTRAL] Oh yeah, sure.
[CUSTOMER][NEUTRAL] Callback number I have here, it's [PII]. And for the policy number I have here, it's 1,797,640.
[AGENT][NEUTRAL] And could you spell your name for me please?
[CUSTOMER][NEUTRAL] Sure. It's [PII], spells like planet [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] And may I please have the patient's name and date of birth?
[CUSTOMER][POSITIVE] You're welcome.
[CUSTOMER][NEUTRAL] Yeah, sure. Uh, patient's name, it's [PII]. Date of birth, [PII].
[AGENT][NEUTRAL] And you were needing benefits, would you like the fax that to be submitted over to you?
[CUSTOMER][POSITIVE] Oh yes, please.
[AGENT][NEUTRAL] OK, may I please have a fax number?
[CUSTOMER][NEUTRAL] Mhm. For the fax number I have here, it's [PII].
[AGENT][POSITIVE] Thank you and I will get that fax submitted over to you. Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Oh, yes. I just wanted to check if there's, oh, may I also ask if this plan is still active?
[AGENT][POSITIVE] Yes, let me pull that up for you.
[CUSTOMER][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] You're welcome, and it does show that the policy is currently active with the effective date of [PII].
[CUSTOMER][NEUTRAL] Mm, [PII].
[CUSTOMER][NEUTRAL] [PII].
[CUSTOMER][NEUTRAL] So, [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][POSITIVE] Perfect. And may I also know if there's any missing tooth costs and waiting period for this patient's plan?
[AGENT][NEUTRAL] Sure. So for the missing tooth cloths, let me pull that up for you.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEGATIVE] It does have a missing tooth louse for this policy.
[AGENT][NEUTRAL] And for the waiting period, which did you need for me to see the waiting period on?
[CUSTOMER][NEUTRAL] Uh, for general, in general.
[AGENT][NEUTRAL] You
[AGENT][NEUTRAL] So for the major expenses or procedures, the member does have a 12 month waiting period.
[CUSTOMER][POSITIVE] Mm, OK. Thank you so much. And
[CUSTOMER][NEUTRAL] So the end date for the missing tooth cause.
[AGENT][NEGATIVE] There is no end date. There is a missing tooth cross on this policy.
[CUSTOMER][POSITIVE] Mm OK. Got it. Thank you so much. And just to make sure if I have here the correct, uh, percentage for this patient's plan, I have here preventive 100%, basic 80%, and major 40%.
[AGENT][NEUTRAL] OK, so in regards to the member's policy, verification of coverage does not guarantee the payment of the claim, as you stated for preventative, they do have up to 100% of UCR and for the basic, they do have up to 80% and for major they have up to 40%.
[CUSTOMER][POSITIVE] Perfect. Thank you so much, uh Ms. [PII]. And uh may I also know the maximum benefits and the deductible as well as its used amount?
[AGENT][NEUTRAL] For this member, calendar year max is $1500 and for the deductible, they have a $50 deductible, but their deductible does not apply to the preventative services.
[CUSTOMER][NEUTRAL] OK, thank you. And there's no used amount?
[AGENT][NEUTRAL] Let me check that for you.
[CUSTOMER][POSITIVE] OK. Thank you so much.
[AGENT][POSITIVE] You're welcome.
[AGENT][NEGATIVE] And as of right now, the member has not used any of their benefits.
[CUSTOMER][POSITIVE] OK, thank you so much.
[CUSTOMER][NEUTRAL] Oh yes, ma'am. So there's no history for this.
[AGENT][NEUTRAL] For the year of [PII], the member has not used any of their benefits.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Checking, let me check, uh.
[CUSTOMER][NEUTRAL] OK, got it. And is there any
[CUSTOMER][NEUTRAL] The frequency for diagnostic and preventative.
[AGENT][NEUTRAL] OK, your phone did go out. Could you repeat that?
[CUSTOMER][NEUTRAL] Oh, I'm so sorry. Yeah. Uh, may I know if there's any history that may affect the frequency for diagnostic and preventative?
[AGENT][NEUTRAL] OK, is there a specific procedure code?
[CUSTOMER][NEUTRAL] Oh yes, sure. I have here for the exams um 0120.
[AGENT][NEUTRAL] So for the exam, the member do have a limited to 2 oral evaluation procedures in any combination per 12 months.
[CUSTOMER][NEUTRAL] OK. Oh, by the way, never mind. Thank you so much, [PII]. I already have here that information. I'm so sorry. Uh, let me just double check here. Oh, just to make sure there's no or coverage for this patient's plan, right?
[AGENT][NEUTRAL] Orthodontic treatment is not covered.
[CUSTOMER][POSITIVE] Mm OK. Thank you so much. And
[CUSTOMER][POSITIVE] OK. As per checking here, I'm all set for these patients plan. Thank you so much, um, [PII].
[AGENT][NEUTRAL] Are you still needing the fax that to be submitted over to you, or do you already have one?
[CUSTOMER][NEUTRAL] Uh
[CUSTOMER][NEUTRAL] Right?
[CUSTOMER][NEUTRAL] Oh, line keeps cutting in and off. Can you repeat that?
[AGENT][NEUTRAL] Do you still need the fax back submitted over to you, or do you already have one?
[CUSTOMER][NEUTRAL] Oh, yes, please.
[AGENT][NEUTRAL] OK, I'm submitting that fax back to you. Is there anything else that I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Uh, no, I'm all good. Uh, may I also have your reference number?
[AGENT][NEUTRAL] The reference number would be my first name, [PII], which is spelled [PII] last initial of [PII] and today's date.
[CUSTOMER][POSITIVE] OK, got it. Thank you so much, [PII], and have a great day ahead.
[AGENT][POSITIVE] You're welcome. Thank you for calling American Public Life. Have a great day as well.