AccountId: 011433970860
ContactId: 5e7dc10a-e729-40db-8364-221ff9355352
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 1080729 ms
Total Talk Time (AGENT): 267376 ms
Total Talk Time (CUSTOMER): 372921 ms
Interruptions: 8
Overall Sentiment: AGENT=0.1, CUSTOMER=-0.6
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/01/21/5e7dc10a-e729-40db-8364-221ff9355352_20250121T19:51_UTC.wav
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[AGENT][POSITIVE] Good afternoon. Thank you for calling APL. My name is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Yeah, hello, this is [PII] for office. How are today.
[AGENT][POSITIVE] I'm doing well. How are you?
[CUSTOMER][POSITIVE] Yeah, I was good, thank you for asking me too.
[AGENT][NEUTRAL] You're welcome. And you said your name is [PII]?
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Uh, my name is [PII].
[AGENT][NEUTRAL] [PII]? OK, and [PII], how may I assist you today?
[CUSTOMER][NEUTRAL] Uh-huh.
[CUSTOMER][NEUTRAL] So, I need the patient benefit details. Can you help me out, please?
[AGENT][NEUTRAL] OK, and [PII], may I have a good contact number in case we're disconnected?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah, the contact number will be [PII].
[CUSTOMER][NEUTRAL] [PII]
[CUSTOMER][NEUTRAL] [PII].
[AGENT][NEUTRAL] Thank you for that. And may I have the member's policy number?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Sure. Uh, it is 0211.
[CUSTOMER][NEUTRAL] 3886.
[AGENT][NEUTRAL] Thank you, hold on one moment.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And you said this is for uh dental benefit details?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right. And can you verify the member's first and last name and date of birth?
[CUSTOMER][NEUTRAL] Sure, business name is?
[CUSTOMER][NEUTRAL] [PII], and date of birth is [PII].
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Thank you for that and all the information provided is a verification of benefits, not a guarantee of payment. And did you need a copy of the dental fax back or did you have particular questions?
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEUTRAL] Um, I have, uh, some questions. Can you tell me that, like, what is the annual maximum benefit for this patient?
[AGENT][NEUTRAL] Um, hold on one moment, let me pull that up.
[AGENT][NEUTRAL] So the calendar year max is $1500 per person.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEGATIVE] And nothing has been used.
[AGENT][NEUTRAL] Um, let me check for you. Hold on one moment.
[CUSTOMER][NEUTRAL] Get
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And on the deductibles?
[AGENT][NEGATIVE] Um, so far for [PII], none of the benefits have been used.
[AGENT][NEUTRAL] There's a $50 deductible per person up to $150 per family, and that has not been used either.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh
[CUSTOMER][NEUTRAL] So can you tell me that like this patient have any medicine tooth cloths or clean painting any waiting period?
[AGENT][NEUTRAL] I'm sorry, can you repeat that slowly, please?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Sure, I this patient have any mission to close or any waiting period?
[AGENT][NEGATIVE] There is a missing tooth cloth.
[AGENT][NEUTRAL] And the policy does have a um waiting period of 12 months for major services, but this policy has been active since [PII], so that waiting period is now over.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] OK, I think we have been satisfied, OK.
[CUSTOMER][NEUTRAL] And uh so I have some procedure code. Can you provide me the frequency of the procedure, please?
[AGENT][NEUTRAL] I'm sorry, can you repeat that slowly, please?
[CUSTOMER][NEUTRAL] Sure, I have some procedure codes. I need the frequency and the percentage. Can you provide me that, please?
[AGENT][NEUTRAL] Uh-huh.
[AGENT][NEUTRAL] Sure, can you provide your list of codes?
[CUSTOMER][NEUTRAL] Uh, you want to take wallet one or one by one?
[AGENT][NEUTRAL] All at once.
[CUSTOMER][NEUTRAL] 1351.
[CUSTOMER][NEUTRAL] 1208
[CUSTOMER][NEUTRAL] Um, 2920, 2929, uh 292.
[AGENT][NEUTRAL] I'm sorry?
[AGENT][NEUTRAL] I'm sorry, hold on. Can you
[AGENT][NEUTRAL] Can you give them slowly, please?
[CUSTOMER][NEUTRAL] Um, yeah. So 1351.
[CUSTOMER][NEUTRAL] 1208.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] 292-02929
[CUSTOMER][NEUTRAL] 29,306,010
[CUSTOMER][NEUTRAL] 605 7
[CUSTOMER][NEUTRAL] 606-542-67
[CUSTOMER][NEUTRAL] 1516
[CUSTOMER][NEUTRAL] [PII] 190222.
[CUSTOMER][NEUTRAL] 90 to 23.
[CUSTOMER][NEUTRAL] 90 to 48.
[CUSTOMER][NEUTRAL] 90 to 30 and the last [PII].
[AGENT][NEUTRAL] OK, and do you mind placing you on a brief hold while I look through the codes for you?
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Mhm. You are on hold.
[AGENT][NEUTRAL] Alright, hold on one moment.
[AGENT][NEUTRAL] 1351.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] 1515, 1520.
[AGENT][NEUTRAL] 3220.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Yeah.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] OK.
[AGENT][NEUTRAL] 311.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEGATIVE] It's making me dizzy.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Hello, [PII].
[CUSTOMER][NEUTRAL] Um, yeah, I'm there.
[AGENT][POSITIVE] Thank you so much for holding. I apologize for that wait. So, of the cost.
[CUSTOMER][NEUTRAL] It's OK.
[AGENT][NEUTRAL] Of the codes that you gave, um, I'll just go down the list of 1351.
[AGENT][NEUTRAL] It's preventative at 100%.
[CUSTOMER][NEUTRAL] Yeah
[AGENT][NEUTRAL] Maximum of 1 procedure per 36 months.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Applications made to permanent molar teeth only?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] And limited to dependent children under age [PII]?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 1208 is not covered?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 2920 is major at 40%.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Maximum of 1 per seven-year period.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And limited to patients age [PII] and over?
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 29, 29 is not covered?
[CUSTOMER][NEUTRAL] it.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 2930 is major at 40%.
[CUSTOMER][NEUTRAL] Um.
[AGENT][NEUTRAL] Maximum, maximum of 1 per seven-year period.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And limited to dependent children under age [PII]?
[CUSTOMER][NEUTRAL] The
[CUSTOMER][NEUTRAL] OK, your name again?
[AGENT][NEUTRAL] [PII] and 1516 are all not covered?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] 3220 is major at 40%.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Limited to dependent children under age [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] 3110 is major at 40%.
[AGENT][NEUTRAL] Code 902-29023.
[CUSTOMER][NEUTRAL] Sure
[CUSTOMER][NEUTRAL] right.
[AGENT][NEUTRAL] 9248 are not covered?
[CUSTOMER][NEUTRAL] I.
[AGENT][NEUTRAL] 9230 is major at 40%.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEGATIVE] And 9944 is not covered.
[CUSTOMER][NEUTRAL] Uh, just a second.
[CUSTOMER][NEUTRAL] 9944 is not covered.
[AGENT][POSITIVE] That's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] And uh can you also tell me that like
[CUSTOMER][NEUTRAL] Um,
[CUSTOMER][NEUTRAL] I
[CUSTOMER][NEGATIVE] 6 implants are not covered.
[CUSTOMER][NEUTRAL] Uh, uh, orthodontic is also not problem am I right?
[AGENT][NEUTRAL] Correct. Orthodontics is not covered.
[CUSTOMER][NEUTRAL] OK. And what about the endodontic? What is the frequency for the endodontic, uh 3310?
[CUSTOMER][NEUTRAL] Mhm.
[AGENT][NEUTRAL] Hold on one moment.
[CUSTOMER][NEUTRAL] I help you?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] 3310. 0, this is a new coat, you have a new set?
[CUSTOMER][NEUTRAL] No, no, no, only one procedure. I left it. That's why I'm asking.
[AGENT][NEUTRAL] 3310. There is, it's under major at at 40%, but there's no uh limitation.
[CUSTOMER][NEUTRAL] And
[CUSTOMER][NEUTRAL] No limitations, OK.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] OK, and grounds are played on the CD.
[AGENT][NEUTRAL] It can be either or.
[CUSTOMER][NEUTRAL] OK. It's either pre prep or either sea I, right?
[AGENT][NEUTRAL] Correct. There's no specification. It can be either one.
[CUSTOMER][NEUTRAL] Mhm. OK.
[CUSTOMER][NEUTRAL] And is there any history for the pano FMX?
[AGENT][NEUTRAL] Um, do you have a code for that?
[CUSTOMER][NEUTRAL] 0330.
[AGENT][NEUTRAL] OK, hold on one moment.
[CUSTOMER][NEUTRAL] Another one.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] Um, there's no claims on file with that, um, procedure code used.
[CUSTOMER][NEUTRAL] OK. And can you check one more patient and can you tell me that the annual maximum that's it for the another patient?
[AGENT][NEUTRAL] Is the same policy number or a family?
[CUSTOMER][NEUTRAL] Uh, um, it is in like gas.
[CUSTOMER][NEUTRAL] It is the same policy number.
[AGENT][NEUTRAL] You said it is the same?
[CUSTOMER][NEUTRAL] And same family.
[CUSTOMER][NEUTRAL] Uh, yeah.
[AGENT][NEUTRAL] OK, so all the benefits are the same.
[CUSTOMER][NEUTRAL] It
[CUSTOMER][NEUTRAL] Yeah, uh, its name is [PII]. Uh, it is active or not? Can you tell me that?
[AGENT][NEUTRAL] Hold on one moment.
[AGENT][NEUTRAL] What's um [PII]'s date of birth?
[CUSTOMER][NEUTRAL] Um, [PII].
[AGENT][NEUTRAL] Yes, the entire policy has been active for all members since [PII].
[CUSTOMER][NEUTRAL] OK. Policy is active. Um, so, [PII], can you send me the benefit package for this for me?
[AGENT][NEUTRAL] OK, what's a good number for the fax back to be sent to?
[CUSTOMER][NEUTRAL] It is 281
[CUSTOMER][NEUTRAL] 499
[CUSTOMER][NEUTRAL] 3197.
[AGENT][NEUTRAL] And do I need to put attention, [PII]?
[CUSTOMER][POSITIVE] Yeah, you can.
[AGENT][NEUTRAL] And that was [PII]?
[CUSTOMER][NEUTRAL] Yeah.
[AGENT][NEUTRAL] All right, so I'm sending that to you now. And was there anything else I can assist you with today, [PII]?
[CUSTOMER][NEUTRAL] Uh, uh, yeah, [PII], can you give me the call reference number please for me?
[AGENT][NEUTRAL] Sure, so there's no call reference number, but you can use my name in today's date. The first initial to my last name is [PII].
[CUSTOMER][NEUTRAL] I
[CUSTOMER][POSITIVE] OK. So thank you and have a nice day. Bye-bye.
[AGENT][POSITIVE] You also, and thanks for calling APL.
[AGENT][NEUTRAL] Bye bye.
[CUSTOMER][NEUTRAL] Hi.