AccountId: 011433970860
ContactId: 5f509c50-4e8f-44e4-9de0-1f12b5662732
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 615590 ms
Total Talk Time (AGENT): 205644 ms
Total Talk Time (CUSTOMER): 179950 ms
Interruptions: 2
Overall Sentiment: AGENT=1.1, CUSTOMER=0.1
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/04/08/5f509c50-4e8f-44e4-9de0-1f12b5662732_20250408T17:50_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How may I help you?
[CUSTOMER][NEUTRAL] Hi, [PII]. This is [PII] calling on behalf of the dental office to check on the eligibility and benefits of a patient on a recorded call. Would you please help me with that?
[AGENT][POSITIVE] Uh, yes ma'am, I can help you uh with the eligibility and benefits. Uh, can I please get your callback number just in case our call is disconnected?
[CUSTOMER][POSITIVE] Thank you.
[CUSTOMER][NEUTRAL] Sure. That is [PII]. It's a direct line.
[AGENT][NEUTRAL] Thank you, ma'am. And then what is the patient's name, date of birth, and policy number?
[CUSTOMER][NEUTRAL] All right. Uh, patient's name is [PII]. Uh, date of birth, [PII], and the subscriber ID is 02603672.
[AGENT][NEUTRAL] OK, let me look that up real quick.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] OK, and if you give me your fax number, I can send you a fax back with the dental benefits and the breakdown of the fee schedule for you.
[CUSTOMER][NEUTRAL] All right. First off, may I please have the free schedule?
[AGENT][NEUTRAL] Yes, uh, the fee schedule is going to be UCR.
[CUSTOMER][NEUTRAL] Got it.
[AGENT][NEUTRAL] And um the effective day the policy is [PII] and the policy is active.
[CUSTOMER][NEUTRAL] Um
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And the coordination of benefit is standard and undo.
[AGENT][NEUTRAL] Fax number?
[AGENT][NEUTRAL] There's no coordination of benefits.
[CUSTOMER][NEUTRAL] Plan runs in the calendar year, [PII].
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] Providers in network.
[AGENT][NEUTRAL] Yes.
[CUSTOMER][NEUTRAL] All right, and yes, I will provide you the facts, but just a few details. May I know what all will be provided in the fact because some facts, uh, we do not get all the information.
[AGENT][NEUTRAL] It will give you, let me look it up real quick.
[AGENT][NEUTRAL] It'll have the benefits broke down by procedure code for you what's covered on the policy if there's any procedure codes that you're looking for that is not on the fax back then it's a non-covered procedure.
[AGENT][POSITIVE] It'll give you all the preventative and basic and basic restorative procedure codes that's covered um it gives you.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right.
[AGENT][NEUTRAL] Waiting periods also gives you frequencies, uh, it gives you the claims mailing address, it gives you exclusions.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right. May I please have the plan maximum details?
[CUSTOMER][NEUTRAL] Hello?
[CUSTOMER][NEUTRAL] Sorry?
[AGENT][NEUTRAL] Hi, Ms. [PII], are you there?
[CUSTOMER][NEUTRAL] Yes, I am here. I'm not sure what just happened.
[AGENT][NEUTRAL] OK, OK, sorry. Yeah, the phone just, uh, it just disconnect. Well, I guess it just had a glitch in it. Um, what is your fax number?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][POSITIVE] All right, no problem.
[CUSTOMER][NEUTRAL] All right. Uh, so the fax number I have here would be
[CUSTOMER][NEUTRAL] OK. [PII].
[CUSTOMER][NEUTRAL] 709.
[CUSTOMER][NEUTRAL] [PII], I repeat, [PII]. And [PII], before that, before that, may I please have the plan maximum details?
[AGENT][NEUTRAL] OK, thanks. Oh, uh-huh.
[AGENT][NEUTRAL] OK, yes ma'am. The maximum, and this is to verify benefits, it's not a guarantee of payment. The calendar year maximum is $500 and the calendar year deductible is $50.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] Only individual, no family deductible.
[AGENT][NEUTRAL] Uh, if it family deductible is $150.
[CUSTOMER][NEUTRAL] Got it. A deductible applies only to basic and major?
[AGENT][NEUTRAL] Yes, it does not apply to preventative.
[CUSTOMER][NEUTRAL] Got it. And then anything used on that?
[AGENT][NEUTRAL] Let me check real quick.
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Just in case if this information are not in the fact, so.
[AGENT][NEUTRAL] Right. There's no history on this, um.
[AGENT][NEUTRAL] Policy, nothing has ever been claimed.
[CUSTOMER][NEUTRAL] Got it. And uh what about the missing two clause or waiting period?
[AGENT][NEUTRAL] Uh, we have a missing tooth cloth, which is on the fax back, um.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] And the waiting period is also on the fax.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right, so are there any downgrades for the filling and crown?
[AGENT][NEUTRAL] No.
[CUSTOMER][NEUTRAL] No downgrades and crown is paid on the seat date or prep date.
[AGENT][NEUTRAL] Set date
[CUSTOMER][NEUTRAL] See the frequency here would be?
[CUSTOMER][NEUTRAL] For the crown
[AGENT][NEUTRAL] Uh, that is also on the.
[CUSTOMER][NEUTRAL] The replacement class.
[AGENT][NEUTRAL] That is also on the uh fax back um.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] All right. And the, the um SRP all quads can be done on the same day or not?
[AGENT][NEUTRAL] Yes. No, no, no, no, no, no. Uh, let me see. It may have an exclusion for quads. Let me look, which is on the fax back also. Um.
[CUSTOMER][NEUTRAL] All right. May I know how long will it take to receive the fax?
[AGENT][NEUTRAL] You'll get it within 5 or 10 minutes.
[CUSTOMER][NEUTRAL] Because the appointment is today.
[AGENT][NEUTRAL] Yeah, 5, 10 minutes at the most.
[CUSTOMER][POSITIVE] Great.
[CUSTOMER][NEUTRAL] Alright.
[AGENT][NEUTRAL] Uh, can I get how to spell your first name?
[CUSTOMER][NEUTRAL] Uh [PII].
[AGENT][NEUTRAL] [PII]. OK. All right. I'm gonna put you on a quick hold while I get that fax ready for you, Ms. [PII] and I'm going to come back and let you know that it's been.
[CUSTOMER][NEUTRAL] Alright, alright.
[CUSTOMER][NEUTRAL] All right, sure.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][NEUTRAL] Did you hear me say I was gonna put you on hold? I'll come back as soon as I have the fax.
[CUSTOMER][NEUTRAL] Yes, yes, yes, I heard that.
[AGENT][NEUTRAL] I'll be back with you just as soon as I have this fax sent, OK?
[CUSTOMER][NEUTRAL] OK. Would you put it to my attention?
[AGENT][POSITIVE] Yes, ma'am. I will put it to your attention. Thank you, ma'am.
[CUSTOMER][POSITIVE] All right. Thank you.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[CUSTOMER][NEGATIVE] You are on hold.
[AGENT][POSITIVE] Thank you for holding for me, Ms. [PII]. I have that fax on its way to you now.
[CUSTOMER][NEUTRAL] Hm.
[CUSTOMER][POSITIVE] Great. Thank you very much. And may I please have the reference number of the call?
[AGENT][NEUTRAL] Yes ma'am, you can use my name [PII]
[AGENT][NEUTRAL] And today's date.
[CUSTOMER][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] All right, got it. And sorry, just to confirm one more thing, the co-insurance for all the uh covered services will also be provided, right?
[AGENT][POSITIVE] Yes, everything will be on the fax back that you need.
[CUSTOMER][POSITIVE] Great then.
[CUSTOMER][POSITIVE] All right, thank you very much, [PII]. Have a wonderful day and bye for now.
[AGENT][POSITIVE] You're very welcome.
[AGENT][POSITIVE] Oh, you're very welcome, Ms. [PII]. Is there anything else I can do for you before we go?
[CUSTOMER][NEUTRAL] All right.
[CUSTOMER][NEUTRAL] Right.
[CUSTOMER][POSITIVE] Uh, no, that's all for for now. Thank you once again. Have a great day.
[AGENT][NEUTRAL] [PII]
[AGENT][NEUTRAL] Bye-bye, Ms. [PII].
[CUSTOMER][NEUTRAL] All right, bye now.